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 ISSN 0007-0963.

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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
Subjects:	R Medicine > RL Dermatology
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
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:	Date Event 9 April 2017 Available 5 April 2017 Accepted
DOI:	10.1111/bjd.15561
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	12 April 2017
Date of first compliant Open Access:	1 June 2017
Funder:	National Institute for Health Research (Great Britain). Applied Research Programme (ARP NIHR)
Grant number:	RP-PG-0407-10177
Contributors:	Contribution Name Contributor ID Research Group The UK Dermatology Clinical Trials Network , STOP GAP team UNSPECIFIED

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