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PGI10 Once daily mesalazine for maintaining remission is cost-saving compared to twice daily mesalazine: an economic evaluation based on the podium randomised controlled trial [Abstract]

Connolly, M., Nielsen, S. K., Currie, Craig John and Poole, Christopher David 2008. PGI10 Once daily mesalazine for maintaining remission is cost-saving compared to twice daily mesalazine: an economic evaluation based on the podium randomised controlled trial [Abstract]. Value in Health 11 (6) , A521. 10.1111/j.1524-4733.2008.00453_2.x

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Abstract

OBJECTIVES: Standard practice to maintain remission in ulcerative colitis (UC) consists of daily mesalazine therapy. However, frequency of dosing can lead to poor adherence and increased failure rates. The PODIUM (PentasaTM Once Daily In UC Maintenance) randomized control trial showed 2g once daily (OD) to be superior to twice daily (BD) dosing for maintaining remission. As maintenance therapy for UC evolves to once daily regimens, we sought to establish whether this new treatment paradigm is cost-effective by considering costs in relation to outcomes. METHODS: An economic evaluation was conducted to compare costs and outcomes from the PODIUM trial. Cost data was obtained from published sources. The main outcome considered was quality-adjusted life-years (QALYs) based on health state utilities derived from the primary outcome measure, remission without relapse at 12 months, defined by a UCDAI score <1. The probability of relapse (defined by UCDAI > 2, or UCDAI = 2 with treatment adjusted) for OD and BD dosing were based on results from the PODIUM study. The economic evaluation consisted of two health states: 1) remission, and 2) active UC. Model duration was one year. Active UC was assessed and treated according to British Society of Gastroenterology guidelines. RESULTS: Annual average treatment costs for OD and BD were £654 (95% CI: £536–£759) and £747 (£620–£860), respectively with an average per person savings of £93. There was no difference in annual costs of mesalazine with OD and BD. Average annual costs of ancillary care for relapse for OD and BD were £307 (£241–£383) and £396 (£320–£483), respectively. Based on the cost savings identified with OD this would represent an annual savings of £46,500 in a District General Hospital serving a Primary Care population of 500 UC patients. Treatment with OD 2g mesalazine resulted in an incremental QALY improvement of 0.004, indicating it was the dominant treatment option (ie. improved outcomes and cost-saving). Variations in parameter estimates in the sensitivity analysis indicated that mesalazine had >0.94 probability of being cost-effective compared to BD based on accepted willingness to pay thresholds within the UK National Health Service. CONCLUSIONS: Once daily 2g mesalazine for maintaining remission in UC is costsaving compared with 1g BD. Cost-savings with OD 2g were achieved by differences in ancillary care between the two treatments attributed to higher failure rates observed with 1g BD.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
Additional Information: ISPOR Eleventh Annual European Congress Research Poster Abstracts
Publisher: Wiley-Blackwell
ISSN: 1098-3015
Last Modified: 04 Jun 2017 03:10
URI: http://orca-mwe.cf.ac.uk/id/eprint/17636

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