Cost effectiveness of ulcerative colitis treatment in Germany: a comparison of two oral formulations of mesalazine

Abstract

BackgroundThe treatment of ulcerative colitis (UC) can place a substantial financial burden on healthcare systems. The anti-inflammatory compound 5-aminosalicylic acid (5-ASA; mesalazine) is the recommended first-line treatment for patients with UC. In this analysis, the incremental cost effectiveness ratio (ICER) of two oral formulations of 5-ASA (Mezavant® and Asacol®) is examined in the treatment of patients with mild-to-moderate, active UC in Germany.MethodsA Markov cohort model was developed to assess the cost effectiveness of Mezavant compared with Asacol over a 5-year period in the German Statutory Health Insurance (SHI). Drug pricing details for 2009 were applied throughout the model, and overall resource use was determined and also fitted to 2009 from published results of a large cross sectional study of German SHI patients. Cost per quality adjusted life year (QALY) was the primary endpoint for this study. Remission rates were obtained using data from a randomised, phase III trial of Mezavant with an active Asacol reference arm and a long-term, open label, safety and tolerability trial of Mezavant. Uncertainty in the study model was assessed using one-way and probabilistic sensitivity analyses applying a Monte Carlo simulation.ResultsOver a 5-year period, healthcare costs for patients receiving Mezavant were 624 Euro lower than for patients receiving Asacol. Additionally, patients receiving Mezavant gained 0.011 QALYs or 18 more days in remission compared with Asacol. One-way sensitivity analyses suggest that these results are driven by both differences in the acquisition cost between mesalazine formulations and differences in treatment efficacy. Furthermore, sensitivity analyses suggest a probability of 76% for cost savings and higher QALYs with Mezavant compared with Asacol. If adherence and its influence on the remission rates and the risk of developing colorectal cancer were included in the model, the results might have even been more favorable to Mezavant due to its once daily dosing regimen.ConclusionsThis model suggests that patients treated with Mezavant may achieve increased time in remission and higher QALYs, with lower direct costs to the SHI when compared with Asacol. Mezavant may therefore be a suitable first-line option for the induction and maintenance of remission in UC.

Real-world biologic treatment and associated cost in patients with inflammatory bowel disease

“…Prenzler et al examined the annual direct health care cost for CD and UC patients in Germany based on the year 2007. They report-ed a cost of € 3767 for CD patients (68.5 % medication, 20.5 % inpatient treatment) and € 2478 for UC patients (74 % medication, 10 % inpatient treatment) [21]. As these data referred to a period 7 -9 years before our observation started and addressed all IBD patients instead of only IBD patients who started a therapy with biologics (as was the case in our study), the cost reported in this study cannot be compared to our results.…”

Rate of Adverse Events and Associated Health Care Costs for the Management of Inflammatory Bowel Disease in Germany

“…Nevertheless, our data confirm the findings of Stark et al, 34 who concluded that the health care items that most influenced IBD-related health care costs were productivity losses and drug cost. Prenzler et al 35 examined the annual direct health care costs for patients with CD and patients with UC in Germany, based on the year 2007. They reported costs of V3767 for patients with CD (68.5% medication; 20.5% inpatient treatment) and V2478 for patients with UC (74% medication; 10% inpatient treatment).…”

Evaluación de coste-efectividad mediante análisis teórico de minimización de costes del uso de dos mesalazinas gastrorresistentes de liberación prolongada en el manejo de la colitis ulcerosa en España

“…Cuando analizamos las evaluaciones económicas de las distintas formulaciones de mesalazina procedentes de estudios internacionales, los trabajos publicados constatan un mayor coste-efectividad de las formulaciones evaluadas en el presente estudio (preparaciones gastrorresistentes de liberación prolongada y toma única) frente a otros tipos de formulaciones de 5-ASA 41,42 , pero no existen estudios que hayan comparado las distintas formulaciones dentro de este último grupo.…”