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VBCR - February 2015, Volume 4, No 1 - Value Propositions

The 2012 American College of Rheumatology Guidelines for Management of Gout recommends xanthine oxidase inhibitor therapy with allopurinol or febuxostat as urate-lowering therapy (ULT) in the treatment of gout. By design, the guidelines do not address cost-effectiveness.

The objective of a recent study was to evaluate the cost-effectiveness of several ULT plans for the management of gout. Using a Markov model to calculate lifetime health benefits, costs, and incremental cost-effectiveness ratios, researchers examined 5 ULT strategies: no treatment; allopurinol- or febuxostat-only therapy; allopurinol-febuxostat sequential therapy; and febuxostat-allopurinol sequential therapy. They evaluated a fixed-dose schedule of febuxostat 80 mg daily and allopurinol 300 mg daily and a dose-escalation schedule of febuxostat ≤120 mg daily and allopurinol ≤800 mg daily.

Results showed that allopurinol-only therapy was cost-saving. Although dose-escalation allopurinol-febuxostat sequential therapy was more effective than dose-escalation allopurinol therapy, it cost more, having an incremental cost-effectiveness ratio of $39,400 per quality-adjusted life-year.

The cost-effectiveness ratios of dose escalation with allopurinol-febuxostat sequential therapy remained lower than the willingness-to-pay threshold of $109,000 per quality-adjusted life-year. The authors concluded that allopurinol single therapy is cost-saving even compared with no treatment and dose-escalation allopurinol-febuxostat sequential therapy is cost-effective compared with accepted willingness-to-pay thresholds. Jutkowitz E, et al. Ann Intern Med. 2014;161(9):617-626.

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Last modified: May 21, 2015
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