School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, UK.
J Med Econ. 2010 Mar;13(1):148-61. doi: 10.3111/13696990903562861.
To perform a cost-utility analysis of a new formulation of mesalazine (Mezavant XL, MMX mesalazine) versus an existing oral mesalazine (Asacol; mesalazine) from the UK National Health Service perspective.
A 5-year Markov cohort model was developed. Costs were obtained from the literature and utilities from an independent study. Uncertainty was evaluated using one-way and probabilistic sensitivity analyses (PSA). The potential effect of dosing frequency on adherence and possible long-term effects of remission maintenance on colorectal cancer (CRC) rates were also investigated.
The model suggested that 5-year therapy with MMX mesalazine was likely to generate gains when compared with mesalazine, including a gain of 0.011 QALYs per patient, 19 more remission days, and 12% fewer hospitalizations and surgical episodes. These gains came at an increase in total NHS direct cost of £8, resulting in an incremental cost-effectiveness ratio (ICER) of £749. The PSA suggested that MMX mesalazine had a 62% chance of resulting in cost savings, and a 74% chance of being cost-effective (£20,000 threshold). Extended analysis including adherence and CRC effects suggested further incremental benefit of MMX mesalazine over mesalazine could be expected. Limitations include uncertainty in extrapolation to a 5-year time horizon and impact of adherence and drug acquisition costs on outcomes.
The pharmacoeconomic analysis suggested that MMX mesalazine is likely to produce small, but worthwhile, increases in total NHS direct cost while increasing time in remission and associated quality of life, when compared with mesalazine. Advantages in adherence to treatment with MMX mesalazine relative to mesalazine suggested that further health gains and cost savings can be obtained. Overall, these results suggest that MMX mesalazine is a cost-effective treatment for UC.
从英国国家医疗服务体系的角度出发，对新型美沙拉嗪制剂（Mezavant XL，MMX 美沙拉嗪）与现有口服美沙拉嗪（Asacol；美沙拉嗪）进行成本-效用分析。
开发了一个为期 5 年的 Markov 队列模型。成本来自文献，效用来自独立研究。使用单因素和概率敏感性分析（PSA）评估不确定性。还研究了剂量频率对依从性的潜在影响以及缓解维持对结直肠癌（CRC）发生率的可能长期影响。
与美沙拉嗪相比，使用 MMX 美沙拉嗪进行 5 年治疗可能会产生获益，包括每位患者增加 0.011 个 QALY，缓解天数增加 19 天，住院和手术次数减少 12%。这些获益伴随着 NHS 直接总成本增加 8 英镑，导致增量成本效益比（ICER）为 749 英镑。PSA 表明，MMX 美沙拉嗪有 62%的可能性节省成本，74%的可能性具有成本效益（20000 英镑阈值）。包括依从性和 CRC 影响的扩展分析表明，与美沙拉嗪相比，MMX 美沙拉嗪可能会带来额外的增量获益。局限性包括对 5 年时间框架的外推存在不确定性以及依从性和药物获取成本对结果的影响。
药物经济学分析表明，与美沙拉嗪相比，MMX 美沙拉嗪在 NHS 直接总成本增加的同时，还可能增加缓解时间和相关生活质量，从而带来小但有价值的获益。与美沙拉嗪相比，MMX 美沙拉嗪在治疗依从性方面的优势表明，还可以获得更多的健康获益和成本节省。总体而言，这些结果表明 MMX 美沙拉嗪是 UC 的一种具有成本效益的治疗方法。
