Cost-effectiveness of febuxostat in chronic gout
Cost-effectiveness of febuxostat in chronic gout
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DOI：
10.1007/s10198-013-0486-z
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发表时间：
2014-06-01
影响因子：
4.4
通讯作者：
Pearson, Isobel V.
中科院分区：
文献类型：
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作者：
Beard, Stephen M.;von Scheele, Birgitta G.;Pearson, Isobel V.
我们的目的是评估2010年提交给苏格兰医学协会（SMC）的非布司他与别嘌呤醇治疗痛风患者的标准临床实践的成本效益数据。一个马尔可夫健康状态模型估计直接健康相关成本和临床效益，表示为质量调整生命年（QALYs）。患有慢性痛风和高尿酸血症的成年人接受每日剂量的别嘌呤醇300 mg或别嘌呤醇300 mg外加非布司他80 mg/120 mg的治疗顺序。达到目标血清尿酸（sUA）水平低于6 mg/dl （0.36 mmol/l）的患者比例与每个sUA水平的效用相关联，以产生增量成本-效果比（ICER）。二线治疗非布司他80mg / 120mg与单独使用别嘌呤醇相比，在5年的时间范围内，每QALY的ICER为3578磅。另外的单变量分析表明，当不同的参数（例如，低剂量和高剂量别嘌呤醇滴定和治疗引起的耀发率的变化）不同时，ICER值是稳健的，每个QALY的范围为2550英镑至7165英镑。与别嘌呤醇相比，非布司他将sUA降低到低于欧洲抗风湿病联盟目标0.36 mmol/l （6 mg/dl）的痛风患者明显更多，其最常用的处方剂量为每天300 mg。SMC接受非布司他作为具有成本效益的降低尿酸盐治疗的二线选择，用于治疗已经发生尿酸沉积的慢性高尿酸血症患者（包括痛风性关节炎和/或痛风性关节炎的病史或存在），当别嘌呤醇治疗不充分、不耐受或禁忌时。
Our objective was to evaluate data on the cost-effectiveness of febuxostat compared with standard clinical practice with allopurinol in patients with gout that was presented to the Scottish Medicines Consortium (SMC) in 2010. A Markov health-state model estimated the direct health-related costs and clinical benefits expressed as quality-adjusted life-years (QALYs). Adults with chronic gout and established hyperuricaemia received treatment sequences of daily doses of allopurinol 300 mg alone or allopurinol 300 mg followed by febuxostat 80 mg/120 mg. The proportion of patients achieving the target serum uric acid (sUA) level of less than 6 mg/dl (0.36 mmol/l) was linked to the utility per sUA level to generate an incremental cost-effectiveness ratio (ICER). Second-line therapy with febuxostat 80 mg/120 mg versus with allopurinol alone resulted in an ICER of A 3,578 pound per QALY over a 5-year time horizon. Additional univariate analyses showed that ICER values were robust and ranged from A 2,550 pound to A 7,165 pound per QALY when different parameters (e.g., low- and high-dose allopurinol titrations and variations in treatment-induced flare rates) were varied. Febuxostat reduces sUA below the European League Against Rheumatism target of 0.36 mmol/l (6 mg/dl) in significantly more patients with gout than allopurinol in its most frequently prescribed dose of 300 mg per day. The SMC accepted febuxostat as cost-effective as a suitable second-line option for urate-lowering therapy for the treatment of patients with chronic hyperuricaemia in conditions where urate deposition has already occurred (including a history or presence of tophus and/or gouty arthritis) when treatment with allopurinol was inadequate, not tolerated, or contraindicated.