Cost-Effectiveness of S-Adenosyl-L-Methionine for Intrahepatic Cholestasis in the United Arab Emirates

Intrahepatic cholestasis (IHC) is a debilitating liver condition characterized by impaired bile formation and flow, leading to the accumulation of bile acids within the liver. This condition can arise from various chronic liver diseases, including alcoholic and nonalcoholic fatty liver disease, and viral hepatitis. IHC can manifest in acute or chronic forms, with the chronic form often resulting in irreversible hepatic damage. Patients with chronic IHC experience a range of symptoms, including pruritus, jaundice, and fatigue, which significantly impact their quality of life. Current treatment options primarily include S-adenosyl-L-methionine (SAMe) and ursodeoxycholic acid (UDCA). However, their cost-effectiveness, especially in specific healthcare settings like the United Arab Emirates (UAE), has not been thoroughly investigated. This study aims to evaluate the cost-effectiveness of SAMe compared to UDCA for treating chronic IHC in the UAE, providing valuable insights for optimizing treatment protocols and allocating healthcare resources.

A multi-faceted economic analysis was conducted, including cost-utility analyses (CUAs) and a cost-effectiveness analysis (CEA). The primary CUA compared SAMe to UDCA, focusing on their impact on pruritus and fatigue. The CEA compared SAMe and UDCA based on changes in key biochemical parameters. An additional CUA compared both SAMe and UDCA to no treatment, considering a broader range of IHC-related comorbidities (jaundice, fatigue, pruritus, and depressed mood).

In the base case CUA, SAMe had an incremental cost-utility ratio (ICUR) of 44,448 AED per quality-adjusted life year (QALY) compared to UDCA. In the CEA, SAMe demonstrated cost-effectiveness in reducing alkaline phosphatase but was less cost-effective for other biomarkers compared to UDCA. In the broader CUA, SAMe had a lower ICUR (41,202 AED/QALY) than UDCA (70,090 AED/QALY) when compared to no treatment. Sensitivity analyses confirmed the robustness of these findings.

SAMe demonstrates cost-effectiveness compared to UDCA and no treatment for chronic IHC in the UAE, particularly when considering its broader impact on comorbidities. These findings support the integration of SAMe into treatment protocols for IHC, potentially improving patient outcomes and optimizing healthcare resource allocation. Further research is needed to address data gaps, especially regarding UDCA's effects on jaundice and depressed mood in IHC.