Abstract:
:Aims: Allopurinol is the most common urate lowering therapy (ULT) used to treat gout but may cause life-threatening severe cutaneous adverse reactions (SCAR) in a small number of patients. Risk of SCAR is increased for patients with the HLA-B*58:01 genotype. When alternative ULT is required, febuxostat or probenecid are recommended. The aim of this study was to conduct a cost-utility analysis of sequential ULT treatment strategies for gout, including strategies with and without HLA-B*58:01 genotyping prior to treatment initiation, with a view to inform optimal gout management in Singapore.Materials and methods: A Markov model was developed from the Singapore healthcare payer perspective. Reflecting local practice, 12 different treatment strategies containing at least one ULT (allopurinol, febuxostat, probenecid) were evaluated in adults with gout. Response rates (SUA < 6mg/dL) were derived from an in-house network meta-analysis and from published literature. Incremental cost-effectiveness ratios (ICERs) were calculated over a 30-year time horizon, with costs and benefits discounted at 3% per annum. Sensitivity analyses were conducted to explore uncertainties.Results: Sequential treatment of allopurinol 300 mg/day-allopurinol 600 mg/day-probenecid ("standard of care") was cost-effective compared to no ULT, with an ICER of SGD1,584/QALY. Allopurinol300-allopurinol600-probenecid-febuxostat sequence compared to allopurinol300-allopurinol600-probenecid had an ICER of SGD11,400/QALY. All other treatment strategies were dominated by preceding strategies. Treatment strategies incorporating HLA-B*58:01 genotyping before ULT use were dominated by the corresponding non-genotyping strategy.Conclusions: Current standard of care (allopurinol300-allopurinol 600-probenecid) for gout is cost-effective compared with no ULT in the local context. Febuxostat is unlikely to be cost-effective in Singapore at current prices unless it is used last-line.
journal_name
J Med Econjournal_title
Journal of medical economicsauthors
Pruis SL,Jeon YK,Pearce F,Thong BY,Aziz MIAdoi
10.1080/13696998.2020.1757456subject
Has Abstractpub_date
2020-08-01 00:00:00pages
838-847issue
8eissn
1369-6998issn
1941-837Xjournal_volume
23pub_type
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journal_title:Journal of medical economics
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.3111/13696998.2010.484323
更新日期:2010-01-01 00:00:00
abstract:AIMS:Access to Critical Cerebral Emergency Support Services (ACCESS) was developed as a low-cost solution to providing neuro-emergent consultations to rural hospitals in New Mexico that do not offer comprehensive stroke care. ACCESS is a two-way audio-visual program linking remote emergency department physicians and th...
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abstract:AIMS:This study analyzed discrepancies in the quantity of medical services supplied by physicians under different payment systems for patients with different health statuses and illnesses by means of a field experiment. METHODS:Based on the laboratory experiment of Heike Hennig-Schmidt, we designed a field experiment ...
journal_title:Journal of medical economics
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doi:10.1080/13696998.2017.1296452
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pub_type: 杂志文章,meta分析,评审
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journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2012.761633
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journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.1080/13696998.2018.1434182
更新日期:2018-05-01 00:00:00
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pub_type: 杂志文章
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更新日期:2019-09-01 00:00:00
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journal_title:Journal of medical economics
pub_type: 杂志文章
doi:10.3111/13696998.2013.787427
更新日期:2013-01-01 00:00:00
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pub_type: 杂志文章
doi:10.1080/13696998.2018.1487447
更新日期:2018-10-01 00:00:00
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pub_type: 杂志文章
doi:10.1080/13696998.2020.1730123
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journal_title:Journal of medical economics
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journal_title:Journal of medical economics
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doi:10.3111/13696998.2010.482904
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pub_type: 杂志文章,评审
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更新日期:2019-03-01 00:00:00
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更新日期:2019-08-01 00:00:00