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Doxycycline compared to prednisolone therapy for patients with bullous pemphigoid : cost-effectiveness analysis of the BLISTER trial
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The UK Dermatology Clinical Trials Network BLISTER Study Group (Including: Mason, James, Chalmers, J. R., Godec, T., Nunn, A. J., Kirtschig, G., Wojnarowska, F., Childs, M., Whitham, D., Schmidt, E., Harman, K, Walton, S., Chapman, A. and Williams, H. C.). (2018) Doxycycline compared to prednisolone therapy for patients with bullous pemphigoid : cost-effectiveness analysis of the BLISTER trial. British Journal of Dermatology, 178 (2). pp. 415-423. doi:10.1111/bjd.16006 ISSN 0007-0963.
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Official URL: https://doi.org/10.1111/bjd.16006
Abstract
Background:
Bullous pemphigoid (BP) is an autoimmune blistering skin disorder associated with significant morbidity and mortality. Doxycycline and prednisolone to treat bullous pemphigoid were compared within a randomised controlled trial (RCT).
Objectives:
To compare the cost-effectiveness of doxycycline-initiated and prednisolone-initiated treatment for patients with BP.
Methods:
a multicentre, parallel-group, investigator-blinded 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, there was no robust difference in costs or QALYs per patient at 1 year comparing doxycycline-initiated therapy with prednisolone-initiated therapy (net cost: £959, 95% CI –£24 to £1941; net QALYs: –0.024, 95% CI –0.088 to 0.041). However, findings varied by baseline blister severity. For patients with mild or moderate blistering (≤30) net costs and outcomes were similar. For patients with severe blistering (>30) net costs were higher (£2558, 95% CI –£82 to £5198) and quality of life poorer (–0.090 QALYs, 95% CI–0.222 to 0.042) for patients starting on doxycycline. The probability that doxycycline would be cost-effective for those with severe pemphigoid was 1.5% at a willingness to pay of £20,000/QALY.
Conclusions:
Consistent with the clinical findings of the BLISTER trial, patients with mild or moderate blistering should receive treatment guided by the safety and effectiveness of the drugs and patient preference - neither strategy is clearly a preferred use of NHS resources. However, prednisolone-initiated treatment may be more cost-effective for patients with severe blistering.
| Item Type: | Journal Article | ||||||||
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| Subjects: | R Medicine > RL Dermatology | ||||||||
| Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences 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 |
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| SWORD Depositor: | Library Publications Router | ||||||||
| Library of Congress Subject Headings (LCSH): | Blisters -- Treatment -- Cost effectiveness, Autoimmune diseases -- Treatment -- Cost effectiveness | ||||||||
| Journal or Publication Title: | British Journal of Dermatology | ||||||||
| Publisher: | Wiley-Blackwell Publishing Ltd. | ||||||||
| ISSN: | 0007-0963 | ||||||||
| Official Date: | February 2018 | ||||||||
| Dates: |
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| Volume: | 178 | ||||||||
| Number: | 2 | ||||||||
| Page Range: | pp. 415-423 | ||||||||
| DOI: | 10.1111/bjd.16006 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Reuse Statement (publisher, data, author rights): | ** From Crossref via Jisc Publications Router. | ||||||||
| Access rights to Published version: | Open Access (Creative Commons) | ||||||||
| Date of first compliant deposit: | 22 November 2017 | ||||||||
| Date of first compliant Open Access: | 8 March 2018 | ||||||||
| RIOXX Funder/Project Grant: |
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