Cost-Effectiveness Analysis of Lesinurad/Allopurinol Versus Febuxostat for the Management of Gout/Hyperuricemia in Italy
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Until very recently the only therapeutic alternative for the management of patients affected by gout/hyperuricemia that did not respond to a first-line treatment based on allopurinol alone or who cannot tolerate allopurinol was febuxostat, a xanthine oxidase non-purine-selective inhibitor. Lately, however, a new therapeutic alternative has become available for the management of this pathology: lesinurad, a urate transporter inhibitor.
To objective of this study was to evaluate the cost effectiveness of lesinurad/allopurinol in comparison with febuxostat as a second-line therapeutic strategy for the management of patients affected by gout and hyperuricemia that did not respond to a first-line therapy based on allopurinol alone.
A Markov model was built based on the natural history of the pathology; patients entered the model according to their level of serum uric acid concentration and flowed across it according to their response to the therapy. The analysis was carried out considering the perspective of the Italian National Health Service on a lifetime horizon and 6-month cycles. Costs and quality-adjusted life-years (QALYs) were discounted at a 3.5% yearly rate. The results of the model were expressed in terms of incremental cost-effectiveness ratio (ICER). Both a one-way and a multi-way Monte–Carlo analysis were carried out in order to check the robustness of the results achieved.
The ICER derived from the comparison was equal to €77.53/QALY on the lifetime horizon, as there was a higher level of costs associated with the combination as compared with febuxostat (€10,658.27 vs. €10,645.87, for a differential of €12.40) and a higher level of QALYs achieved (7.77 vs. 7.61, for a differential of 0.16).
The lesinurad/allopurinol combination is recommended for the treatment of patients affected by gout/hyperuricemia in the Italian Health System as it appears to be cost effective and thus sustainable for the Italian healthcare sector.
The model was adapted from work conducted by MDM Inc.; the original model was built by Kari Kelton, Vice President, Data & Analytics; James Gahn Sr., Research Analyst, Modeling & Computer Science; Robert Klein, Vice President, Healthcare Engineering; and Mark Day, Vice President, Strategy & Operations.
All authors made a substantial contribution to the conception, design, acquisition of data, and related analysis and interpretation and participated in drafting the article and revising it critically and according to its important intellectual content.
Compliance with Ethical Standards
This study was funded by Grunenthal Italia. The views expressed here are those of the authors and not necessarily those of the funders.
Conflict of interest
None of the authors (Dr. Ruggeri, Dr. Basile, Dr. Drago, and Prof. Cicchetti) has any potential conflict of interest related to this study.
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