Global Market Access Solutions, St Prex, Switzerland.
J Crohns Colitis. 2009 Feb;3(1):32-7. doi: 10.1016/j.crohns.2008.10.004. Epub 2008 Dec 6.
Standard practice to maintain remission in ulcerative colitis (UC) consists of daily mesalazine therapy. However, frequent dosing is associated with poor adherence and increased failure rates. The PODIUM (Pentasa™ Once Daily In UC Maintenance) randomised control trial showed 2 g once daily (OD) to be superior to twice daily (BD) dosing for maintaining remission. We sought to determine whether this alternative dosing regimen is cost-effective.
An economic evaluation was conducted to compare costs and outcomes of OD with twice daily (BD) dosing. The main outcome considered was quality-adjusted life years (QALYs) based on health state utilities derived from the primary outcome measure, remission without relapse at 12 months defined by a UCDAI score ≤1. The economic evaluation consisted of two health states: (1) remission and (2) active UC.
Annual average treatment costs for OD and BD dosing were £654 (95% CI: £536-£759) and £747 (£620-£860), respectively with an average per person savings of £93 per year. Average annual costs of ancillary care for relapse for OD and BD dosing were £307 (£241-£383) and £396 (£320-£483), respectively. Treatment with OD 2 g mesalazine resulted in an incremental QALY improvement of 0.004 units, indicating that it was the dominant treatment option (i.e. improved outcomes and cost-saving). Variations in parameter estimates in the sensitivity analysis indicated that mesalazine had >0.95 probability of being cost-effective compared to BD based on accepted willingness to pay thresholds applied by the UK National Health Service.
Once daily 2 g mesalazine for maintaining remission in UC is cost-saving compared with 1 g twice daily. Cost-savings with 2 g once daily were achieved by differences in ancillary care attributed to higher failure rates observed with 1 g twice daily.
溃疡性结肠炎（UC）维持缓解的标准治疗方案包括每天给予美沙拉嗪治疗。然而，频繁给药与较差的依从性和更高的失败率有关。PODIUM（Pentasa™ 每日一次在溃疡性结肠炎维持治疗中的应用）随机对照试验表明，每天 2g 一次（OD）优于每天 2 次（BD）给药，以维持缓解。我们旨在确定这种替代给药方案是否具有成本效益。
进行经济评估以比较 OD 与 BD 给药的成本和结果。主要结果是基于主要结局测量、12 个月时无复发缓解定义为 UCDAI 评分≤1 的健康状态效用得出的质量调整生命年（QALYs）。经济评估包括两种健康状态：（1）缓解和（2）活动期 UC。
OD 和 BD 给药的年平均治疗成本分别为 654 英镑（95%CI：536-759 英镑）和 747 英镑（620-860 英镑），每人每年节省 93 英镑。OD 和 BD 给药的辅助治疗复发年平均成本分别为 307 英镑（241-383 英镑）和 396 英镑（320-483 英镑）。OD 2g 美沙拉嗪治疗可使 QALY 增加 0.004 个单位，表明这是一种占优势的治疗选择（即改善结局和节省成本）。敏感性分析中参数估计的变化表明，与 BD 相比，美沙拉嗪具有 >0.95 的概率具有成本效益，这是基于英国国家卫生服务局采用的可接受的支付意愿阈值。
与 1g 每天 2 次相比，UC 维持缓解的每天 2g 美沙拉嗪治疗可节省成本。与 1g 每天 2 次相比，2g 每天 1 次的成本节约是由于观察到的较高失败率导致辅助治疗的差异所致。
