Jazzar Ahmad, Raja Kaiser, Fasseeh Omar N, Rasmy Ahmed, Gomaa Ahmed, Nasr Naglaa, Fasseeh Ahmad N
Gastroenterology and Hepatology, Burjeel Day Surgery Center, Abu Dhabi, ARE.
Gastroenterology and Hepatology, King's College Hospital London, Dubai, ARE.
Cureus. 2025 Jun 16;17(6):e86124. doi: 10.7759/cureus.86124. eCollection 2025 Jun.
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.
肝内胆汁淤积症（IHC）是一种使人虚弱的肝脏疾病，其特征是胆汁形成和流动受损，导致肝脏内胆汁酸积聚。这种情况可由多种慢性肝病引起，包括酒精性和非酒精性脂肪性肝病以及病毒性肝炎。IHC可表现为急性或慢性形式，慢性形式常导致不可逆的肝损伤。慢性IHC患者会出现一系列症状，包括瘙痒、黄疸和疲劳，这会严重影响他们的生活质量。目前的治疗选择主要包括S-腺苷-L-蛋氨酸（SAMe）和熊去氧胆酸（UDCA）。然而，它们的成本效益，尤其是在阿拉伯联合酋长国（UAE）等特定医疗环境中的成本效益，尚未得到充分研究。本研究旨在评估在阿联酋，SAMe与UDCA治疗慢性IHC的成本效益，为优化治疗方案和分配医疗资源提供有价值的见解。
进行了多方面的经济分析，包括成本效用分析（CUA）和成本效益分析（CEA）。主要的CUA将SAMe与UDCA进行比较，重点关注它们对瘙痒和疲劳的影响。CEA根据关键生化参数的变化比较SAMe和UDCA。另一项CUA将SAMe和UDCA与不治疗进行比较，考虑了更广泛的与IHC相关的合并症（黄疸、疲劳、瘙痒和情绪低落）。
在基础病例CUA中，与UDCA相比，SAMe的增量成本效用比（ICUR）为每质量调整生命年（QALY）44,448阿联酋迪拉姆。在CEA中，SAMe在降低碱性磷酸酶方面显示出成本效益，但与UDCA相比，在其他生物标志物方面成本效益较低。在更广泛的CUA中，与不治疗相比，SAMe的ICUR（41,202阿联酋迪拉姆/QALY）低于UDCA（70,090阿联酋迪拉姆/QALY）。敏感性分析证实了这些结果的稳健性。
在阿联酋，与UDCA和不治疗相比，SAMe治疗慢性IHC具有成本效益，特别是考虑到其对合并症的更广泛影响时。这些发现支持将SAMe纳入IHC的治疗方案，可能改善患者预后并优化医疗资源分配。需要进一步研究以填补数据空白，特别是关于UDCA对IHC中黄疸和情绪低落的影响。
