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A cost effectiveness analysis of urate lowering drugs in nontophaceous recurrent gouty arthritis
1Division of Rheumatology, Escola Paulista de Medicina, Sao Paulo, Brazil.
Insights
Urate-lowering drug (ULD) treatment for gout is cost-effective, especially for patients with two or more attacks annually. Generic allopurinol offers the most cost-effective regimen for managing gout flares.
Area of Science:
- Health Economics
- Rheumatology
- Pharmacoeconomics
Background:
- Gouty arthritis, particularly nontophaceous gout with recurrent attacks, poses a significant health and economic burden.
- Urate-lowering drugs (ULDs) are a cornerstone in managing gout, but their cost-effectiveness in a Canadian healthcare context requires evaluation.
Purpose of the Study:
- To determine the cost-effectiveness of urate-lowering drugs (ULDs) for treating nontophaceous gouty arthritis with recurrent attacks in Canada.
- To identify the most cost-effective ULD regimen available.
Main Methods:
- A decision analysis model was developed using a hypothetical cohort of patients experiencing 1-4 gout attacks per year.
- Costs and probabilities were sourced from published literature, with effectiveness measured by averted attacks.
- Sensitivity analyses were conducted to assess ULD therapy under various scenarios.
Main Results:
- For patients with one attack/year, ULD treatment cost Cdn $426.27 versus $267.27 for no ULDs, with incremental cost-effectiveness ratios ranging from $99.59 to $489.26 per attack averted.
- ULD treatment becomes cost-saving for patients experiencing two or more attacks annually.
- Generic allopurinol demonstrated the lowest incremental cost-effectiveness ratio among available ULDs.
Conclusions:
- Urate-lowering drug (ULD) treatment is a cost-effective strategy for managing recurrent gouty arthritis.
- ULD therapy is economically beneficial, particularly for patients with frequent gout attacks (≥2 per year).
Objective:
To determine in a Canadian health care setting the cost effectiveness of urate lowering drugs (ULD) in the treatment of nontophaceous gouty arthritis with recurrent attacks and to evaluate the least costly regimen among available ULD.
Methods:
A decision analysis model was designed using hypothetical cohort of patients who present 1 to 4 recurrent attacks/year. It incorporated costs and probabilities estimated from the published literature. Effectiveness was defined as the number of recurrent attacks averted by each treatment strategy (ULD or No ULD). The incremental cost effectiveness ratio was defined as the ratio of the additional cost incurred by a management strategy compared with the additional benefit derived from it. A multiway sensitivity analysis was built to allow the modelling of extreme case scenarios favoring (best ULD scenario) and disfavoring (worst ULD scenario) the ULD therapy.
Results:
Using the baseline scenario estimates for the hypothetical cohort of patients presenting one attack/year, the total annualized costs per patient associated with ULD and No ULD treatment were Cdn $426.27 and 267.27, respectively. The average cost effectiveness ratios were $592.25 and 5,345.37, respectively, per attack averted. For this cohort of patients the incremental cost effectiveness ratio ranged from $99.59 (best ULD scenario) to 489.26 (worst ULD scenario). The treatment with ULD is cost saving if patients present 2 or more attacks/year. Allopurinol in its generic formulation was the ULD that presented the lowest incremental cost effectiveness ratio.
Conclusion:
ULD treatment is cost effective. It is also saving if patients present 2 or more recurrent attacks/year.