Cost-effectiveness and cost-utility of optimized mercaptopurine treatment versus placebo in ulcerative colitis patients: The randomized controlled OPTIC trial.

IF 5.8 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Mark Löwenberg, Marit van Barreveld, Adriaan Volkers, Sara van Gennep, Marjolijn Duijvestein, Adriaan A van Bodegraven, Melanie S Hulshoff, Jeroen M Jansen, Dirk van Asseldonk, Rachel West, Geert D'Haens, Nanne de Boer, Marcel G W Dijkgraaf
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引用次数: 0

Abstract

Background and aims: We assessed the cost-effectiveness and cost-utility of therapeutic drug monitoring (TDM)-guided mercaptopurine treatment compared with placebo in ulcerative colitis (UC) patients failing 5-aminosalicylates.

Methods: Data were gathered alongside the randomized controlled OPTIC trial (EudraCT: 2015-005260-41). The evaluation was performed from a health care and societal perspective as cost-effectiveness and cost-utility analyses with a time horizon of one year. Volumes and costs of in-hospital care, out-of-hospital care, out-of-pocket expenses and productivity loss were assessed. The main outcomes were the extra costs per additional patient who achieved clinical remission and endoscopic improvement at 52 weeks (responders) and extra costs per quality-adjusted life-year (QALY) gained.

Results: In total, 59 patients were randomized to the intervention (n = 29) and control (n = 30) group. Non-significant differences in costs were €63 (-€1267 to €1434; P = 0.93) in favour of placebo from a health care perspective and -€742 (-€3683 to €2016; P = 0.64) in favour of mercaptopurine from a societal perspective. The higher proportion of responders and a non-significant QALY difference of 0.0475 (-0.024-0.117) (P = 0.184) favouring patients on mercaptopurine treatment resulted in €165 extra costs per additional responder and €1326 extra costs per QALY gained from a health care perspective. From a societal perspective, dominance over placebo was observed with cost savings of €1937 per additional responder and €15,621 per QALY gained. The probability of optimised mercaptopurine treatment being cost-effective was 0.80 at a willingness to pay per additional QALY of €20,000.

Conclusions: TDM-based mercaptopurine treatment in UC patients failing 5-aminosalicylates is a cost-effective strategy from a societal perspective.

优化巯嘌呤治疗与安慰剂治疗溃疡性结肠炎的成本效益和成本效用:随机对照 OPTIC 试验。
背景和目的:我们评估了治疗药物监测(TDM)指导下的巯嘌呤治疗与安慰剂治疗5-氨基水杨酸类药物无效的溃疡性结肠炎(UC)患者的成本效益和成本效用:在随机对照 OPTIC 试验(EudraCT:2015-005260-41)的同时收集数据。评估从医疗保健和社会角度出发,以一年为时间跨度进行成本效益和成本效用分析。评估了院内护理、院外护理、自付费用和生产力损失的数量和成本。主要结果是在52周时临床缓解和内镜改善的每名额外患者(应答者)的额外成本,以及每获得一个质量调整生命年(QALY)的额外成本:共有 59 名患者被随机分配到干预组(29 人)和对照组(30 人)。从医疗保健角度看,安慰剂的成本为63欧元(-1267欧元至1434欧元;P = 0.93),而从社会角度看,巯嘌呤的成本为-742欧元(-3683欧元至2016欧元;P = 0.64),差异不显著。巯嘌呤治疗患者的应答者比例较高,QALY 差异为 0.0475 (-0.024-0.117) (P = 0.184),但并不显著,因此从医疗角度看,每增加一名应答者需多花费 165 欧元,每获得一个 QALY 需多花费 1326 欧元。从社会角度来看,巯嘌呤治疗优于安慰剂治疗,每增加一名应答者可节省成本 1937 欧元,每获得一个 QALY 可节省成本 15621 欧元。在每增加一个QALY的支付意愿为20,000欧元时,优化巯嘌呤治疗具有成本效益的概率为0.80:结论:从社会角度来看,对5-氨基水杨酸盐治疗失败的UC患者进行基于TDM的巯嘌呤治疗是一种具有成本效益的策略。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
United European Gastroenterology Journal
United European Gastroenterology Journal GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
10.50
自引率
13.30%
发文量
147
期刊介绍: United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.
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