PMID- 26535593
OWN - NLM
STAT- MEDLINE
DCOM- 20161216
LR  - 20220311
IS  - 1941-837X (Electronic)
IS  - 1369-6998 (Linking)
VI  - 19
IP  - 3
DP  - 2016
TI  - Febuxostat in the management of gout: a cost-effectiveness analysis.
PG  - 265-76
LID - 10.3111/13696998.2015.1116990 [doi]
AB  - OBJECTIVE: To determine the cost-effectiveness of febuxostat vs allopurinol for 
      the management of gout. METHODS: A stochastic microsimulation cost-effectiveness 
      model with a US private-payer perspective and 5-year time horizon was developed. 
      Model flow based on guideline and real-world treatment paradigms incorporated 
      gout flare, serum uric acid (sUA) testing, treatment titration, discontinuation, 
      and adverse events, chronic kidney disease (CKD) incidence and progression, and 
      type 2 diabetes mellitus (T2DM) incidence. Outcomes were estimated for the 
      general gout population and for gout patients with CKD stages 3/4. Modeled 
      treatment interventions were daily oral febuxostat 40-80 mg and allopurinol 
      100-300 mg. Baseline patient characteristics were taken from epidemiologic 
      studies, efficacy data from randomized controlled trials, adverse event rates 
      from package inserts, and costs from the literature, government sources, and 
      expert opinion. Eight clinically-relevant incremental cost-effectiveness ratios 
      were estimated: per patient reaching target sUA, per flare avoided, per CKD 
      incidence, progression, stages 3/4 progression, and stage 5 progression avoided, 
      per incident T2DM avoided, and per death avoided. RESULTS: Five-year incremental 
      cost-effectiveness ratios for the general gout population were $5377 per patient 
      reaching target sUA, $1773 per flare avoided, $221,795 per incident CKD avoided, 
      $29,063 per CKD progression avoided, $36,018 per progression to CKD 3/4 avoided, 
      $71,426 per progression to CKD 5 avoided, $214,277 per incident T2DM avoided, and 
      $217,971 per death avoided. In patients with CKD 3/4, febuxostat dominated 
      allopurinol for all cost-effectiveness outcome measures. CONCLUSIONS: Febuxostat 
      may be a cost-effective alternative to allopurinol, especially for patients with 
      CKD stages 3 or 4.
FAU - Smolen, Lee J
AU  - Smolen LJ
AD  - a a Medical Decision Modeling Inc. , Indianapolis , IN , USA.
FAU - Gahn, James C
AU  - Gahn JC
AD  - a a Medical Decision Modeling Inc. , Indianapolis , IN , USA.
FAU - Mitri, Ghaith
AU  - Mitri G
AD  - b b naviHealth, Inc. Brentwood , TN , USA.
FAU - Shiozawa, Aki
AU  - Shiozawa A
AD  - c c Takeda Pharmaceuticals International, Inc. , Deerfield , IL , USA.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20151123
PL  - England
TA  - J Med Econ
JT  - Journal of medical economics
JID - 9892255
RN  - 0 (Gout Suppressants)
RN  - 101V0R1N2E (Febuxostat)
RN  - 268B43MJ25 (Uric Acid)
RN  - 63CZ7GJN5I (Allopurinol)
SB  - IM
MH  - Adult
MH  - Aged
MH  - Allopurinol/economics/therapeutic use
MH  - Cost-Benefit Analysis
MH  - Disease Management
MH  - Febuxostat/*economics/*therapeutic use
MH  - Female
MH  - Gout/*drug therapy
MH  - Gout Suppressants/*economics/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - United States
MH  - Uric Acid/blood
OTO - NOTNLM
OT  - Allopurinol
OT  - Cost-benefit analysis
OT  - Economics, pharmaceutical
OT  - Febuxostat
OT  - Gout
OT  - Rheumatology
EDAT- 2015/11/05 06:00
MHDA- 2016/12/17 06:00
CRDT- 2015/11/05 06:00
PHST- 2015/11/05 06:00 [entrez]
PHST- 2015/11/05 06:00 [pubmed]
PHST- 2016/12/17 06:00 [medline]
AID - 10.3111/13696998.2015.1116990 [doi]
PST - ppublish
SO  - J Med Econ. 2016;19(3):265-76. doi: 10.3111/13696998.2015.1116990. Epub 2015 Nov 
      23.