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Ciclosporin compared to prednisolone therapy for patients with pyoderma gangrenosum : cost-effectiveness analysis of the STOP GAP trial
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Mason, James, Thomas, K. S., Ormerod, A. D., Craig, F. E., Mitchell, E., Norrie, J. and Williams, H. C. (2017) Ciclosporin compared to prednisolone therapy for patients with pyoderma gangrenosum : cost-effectiveness analysis of the STOP GAP trial. British Journal of Dermatology . doi:10.1111/bjd.15561
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Official URL: http://dx.doi.org/10.1111/bjd.15561
Abstract
Background:
Pyoderma gangrenosum (PG) is a painful, ulcerating skin disease with poor evidence for management. Prednisolone and ciclosporin are the most commonly used treatments, although not previously compared within a randomised controlled trial (RCT)
Objectives:
To compare the cost-effectiveness of ciclosporin and prednisolone-initiated treatment for patients with PG.
Methods:
Quality-of-life (EuroQoL EQ-5D-3L) and resource data were collected as part of the STOP-GAP trial: a multicentre, parallel-group, observer-blind RCT. Within-trial analysis used bivariate regression of costs and QALYs, with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective.
Results:
In the base case analysis, when compared with prednisolone, ciclosporin was cost-effective due to a reduction in costs (net cost: -£1160; 95%CI: (-2991 to 672) and improvement in quality of life (net QALYs: 0.055; 95%CI: 0.018 to 0.093). However, this finding appears driven by a minority of patients with large lesions (≥20cm2) (net cost: -£5310; 95%CI: -9729 to -891; net QALYs: 0.077; 95%CI: 0.004 to 0.151). The incremental cost-effectiveness of ciclosporin for the majority of patients with smaller lesions was £23,374/QALY although the estimate is imprecise: the probability of being cost-effective at a willingness to pay of £20,000/QALY was 43%.
Conclusions:
Consistent with the clinical findings of the STOP-GAP trial, patients with small lesions should receive treatment guided by the side effect profiles of the drugs and patient preference - neither strategy is clearly a preferred use of NHS resources. However, ciclosporin-initiated treatment may be more cost-effective for patients with large lesions.
| Item Type: | Journal Article | ||||||
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| Subjects: | R Medicine > RL Dermatology | ||||||
| Divisions: | Faculty of Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Pyoderma -- Treatment -- Cost effectiveness | ||||||
| Journal or Publication Title: | British Journal of Dermatology | ||||||
| Publisher: | Wiley-Blackwell Publishing Ltd. | ||||||
| ISSN: | 0007-0963 | ||||||
| Official Date: | 9 April 2017 | ||||||
| Dates: |
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| Date of first compliant deposit: | 12 April 2017 | ||||||
| DOI: | 10.1111/bjd.15561 | ||||||
| Status: | Peer Reviewed | ||||||
| Publication Status: | Published | ||||||
| Access rights to Published version: | Open Access | ||||||
| Funder: | National Institute for Health Research (Great Britain). Applied Research Programme (ARP NIHR) | ||||||
| Grant number: | RP-PG-0407-10177 | ||||||
| Contributors: |
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