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Cost-effectiveness of an adherence-enhancing intervention for gout based on real-world data.

Abstract：

AIM:Medication non-adherence influences outcomes of therapies for chronic diseases. Allopurinol is a cornerstone therapy for patients with gout; however, non-adherence to allopurinol is prevalent in Singapore and limits its effectiveness. Between 2008-2010, an adherence-enhancing program was implemented at the rheumatology division of a public tertiary hospital. The cost-effectiveness of this program has not been fully evaluated. With healthcare resources being finite, the value of investing in adherence-enhancing interventions should be ascertained. This study aims to evaluate the cost-effectiveness of this adherence-enhancing program to inform optimal resource allocation toward better gout management. METHOD:Adopting a real-world data approach, we utilized patient clinical and financial records generated in their course of routine care. Intervention and control groups were identified in a standing database and matched on nine risk factors through propensity score matching. Cost and effect data were followed through 1-2 years. A decision tree was developed in TreeAge using a societal perspective. Deterministic and probabilistic sensitivity analyses were performed to assess parameter uncertainty. RESULTS:At an assumed willingness-to-pay threshold of $50 000 USD ($70 000 SGD) per quality-adjusted life year (QALY), the intervention had an 85% probability of being cost-effective compared to routine care. The incremental cost-effectiveness ratio was $12 866 USD per QALY for the base case and ranged from $4 139 to $21 593 USD per QALY in sensitivity analyses. CONCLUSION:The intervention is cost-effective in the short-term, although its long-term cost-effectiveness remains to be evaluated.

journal_name

Int J Rheum Dis

journal_title

International journal of rheumatic diseases

authors

Lin LW,Teng GG,Lim AYN,Yoong JS,Zethraeus N,Wee HL

doi

10.1111/1756-185X.13446

subject

Has Abstract

pub_date

2019-04-01 00:00:00

pages

545-554

issue

4

eissn

1756-1841

issn

1756-185X

journal_volume

22

pub_type

杂志文章

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