Payer decision-making with limited comparative and cost effectiveness data: the case of new pharmacological treatments for gout

Abstract

Although febuxostat trials included allopurinol as a comparator, methodological limitations make comparative effectiveness evaluations difficult. However, when available trial data were input to a decision analytic model, the authors found that a significant reduction in febuxostat cost would be required in order for it to dominate allopurinol in cost effectiveness analysis. This case exemplifies the challenges of using clinical trial data in comparative and cost effectiveness analyses.

Cost-Effectiveness Analysis of Allopurinol Versus Febuxostat in Chronic Gout Patients: A U.S. Payer Perspective

“…A study by Meltzer et al (2012) found that a significant reduction in febuxostat drug cost would be required for it to dominate allopurinol. 19 Although, the authors found febuxostat to be a cost-effective option, they did not account for relevant health care resource costs typically associated with gout patients.…”

“…19 Although, the authors found febuxostat to be a cost-effective option, they did not account for relevant health care resource costs typically associated with gout patients. For instance, febuxostat incurs additional costs for liver function test abnormalities and the expected cost for 20 Although this study found fewer gout flares, fewer CKD stage 5 patients with gout, and reduced overall costs, the authors accounted for a specific subgroup of gout patients, thereby reducing the applicability of their study findings.…”

“…[16][17][18] On the other hand, other studies either did not account for costs associated with health care resources typically reported in patients with gout or were evaluated only for a specific subgroup of gout patients (i.e., chronic kidney disease (CKD) stage 3/4 gout patients with sUA ≥ 8 mg/dL). 19,20 To address this gap in knowledge and to fully understand the complete economic value over long-term sequelae, a Markov model was developed to compare the cost-effectiveness of allopurinol with febuxostat over a 5-year time period.…”

“…6,[12][13][14][15] Several studies have evaluated the cost-effectiveness of febuxostat compared with allopurinol in patients with gout where the findings support the use of febuxostat as a cost-effective strategy. [16][17][18][19][20] However, some of these studies cannot be extrapolated to the U.S. set- …”

“…Several other studies have used the ICER metric to assess the costeffectiveness of allopurinol versus febuxostat. [16][17][18][19][20] As a part of PSAs performed 10,000 iterations of the model, which demonstrated that febuxostat had a 51.5% chance of being costeffective at a WTP threshold of $10,000 per treatment success ( Figure 3) and a 65% chance of being cost-effective at a WTP threshold of $50,000 per treatment success.…”