Decision Tree Construction and Cost-Effectiveness Analysis of Treatment of Ulcerative Colitis With Pentasa®mesalazine 2 G Sachet

Abstract

-Context -Unspecified Ulcerative Rectocolitis is a chronic disease that affects between 0.5 and 24.5/10 5 inhabitants in the world. National and international clinical guidelines recommend the use of aminosalicylates (including mesalazine) as first-line therapy for induction of remission of unspecified ulcerative rectocolitis, and recommend the maintenance of these agents after remission is achieved. However, multiple daily doses required for the maintenance of disease remission compromise compliance with treatment, which is very low (between 45% and 65%). Use of mesalazina in granules (2 g sachet) once daily -Pentasa ® sachets 2 g -can enhance treatment adherence, reflecting in an improvement in patients' outcomes. Objective -To evaluate the evidence on the use of mesalazine for the maintenance of remission in patients with unspecified ulcerative rectocolitis and its effectiveness when taken once versus more than once a day. From an economic standpoint, to analyze the impact of the adoption of this dosage in Brazil's public health system, considering patients' adherence to treatment. Methods -A decision tree was developed based on the Clinical Protocol and Therapeutic Guidelines for Ulcerative Colitis, published by the Ministry of Health in the lobby SAS/MS n° 861 of November 4 th, 2002 and on the algorithms published by the Associação Brasileira de Colite Ulcerativa e Doença de Crohn, aiming to get the cost-effectiveness of mesalazine once daily in granules compared with mesalazine twice daily in tablets. ResultsThe use of mesalazine increases the chances of remission induction and maintenance when compared to placebo, and higher doses are associated with greater chance of success without increasing the risk of adverse events. Conclusion -The use of a single daily dose in the maintenance of remission is effective and related to higher patient compliance when compared to the multiple daily dose regimens, with lower costs.

Modelling the benefits of an optimised treatment strategy for 5-ASA in mild-to-moderate ulcerative colitis

“…22 In all cases, these analyses showed that the optimised therapy was the dominant treatment option (lower costs and higher-quality-adjusted life-years). [17][18][19][20][21][22] A further study focused on the costs and health-related quality of life (HRQoL) impacts of active UC and showed that there were high costs of care (direct and indirect) and adverse effects on HRQOL. 35 Combined with the results from our modelling, it would suggest that the optimised treatment pathway is highly likely to be cost-saving and therefore likely to be dominant over the standard treatment pathway.…”

“…3 During remission of UC on 5-ASA maintenance therapy, an additional optimisation step is to monitor disease activity through objective markers including endoscopic disease activity, imaging modalities including intestinal ultrasound and biomarkers, such as faecal calprotectin (FC) levels which can act as a trigger for 5-ASA dose escalation, when necessary. 10 While there is a strong rationale for optimisation and good supporting evidence for individual aspects of 5-ASA optimisation, [17][18][19][20][21][22] there has been less investigation into the benefits of a fully optimised treatment pathway in mild-to-moderate UC. This study aimed to use published evidence to model the benefits of the dose optimisation strategy in both induction and maintenance of remission in patients with mild-to-moderately active UC.…”

“…While there is a strong rationale for optimisation and good supporting evidence for individual aspects of 5-ASA optimisation,17–22 there has been less investigation into the benefits of a fully optimised treatment pathway in mild-to-moderate UC. This study aimed to use published evidence to model the benefits of the dose optimisation strategy in both induction and maintenance of remission in patients with mild-to-moderately active UC.…”

The use of Decision Tree in Breast Cancer-Related Research: a Scoping Analysis Based on Scopus-Indexed Articles

“…It uses graphical approach to make comparisons of "competing alternatives and assign values to those alternatives by combining uncertainties, costs, and payoffs into specific numerical values" [76]. Similarly, a study presented the cost-effectiveness assessment for the treatment of ulcerative colitis by using decision tree in a clinical trial [78].…”

Clinical and economic efficiency of multi-matrix mesalazine in ulcerative colitis treatment in the healthcare system of the Republic of Kazakhstan

“…В настоящее время, исследования по сравнительной экономической оценке различных лекарственных форм, дозировок и режимов применения препаратов 5-АСК имеют высокую актуальность. В частности, подобные исследования проводились в США, Японии, Великобритании, Нидерландах, Испании и других странах [4][5][6][7][8][9][10][11][12]. Однако, в РК, ранее подобные исследования не проводились, более того, не обнаружено также исследований по сравнительной клинико-экономической оценке стратегий применения месалазина ММХ и месалазина с времязависимым высвобождением лекарства и зарубежом, которые послужили объектом нашего исследования.…”