Cost effectiveness of ulcerative colitis treatment in Germany: A comparison of two oral formulations of mesalazine
Creators: name: Prenzler, Anne
name: Yen, Linnette
name: Mittendorf, Thomas
name: Schulenburg, Johann-Matthias Graf Von Der
Publisher: name: London : BioMed Central Ltd.
Year: 2011
Subjects: subject: Asacol
subject: cost analysis
subject: cost effectiveness
subject: mesalazines
subject: Mezavant
subject: Ulcerative colitis
subject: mesalazine
subject: nonsteroid antiinflammatory agent
subject: article
subject: comparative study
subject: cost
subject: cost benefit analysis
subject: drug dosage form
subject: economics
subject: Germany
subject: human
subject: oral drug administration
subject: probability
subject: ulcerative colitis
subject: Administration, Oral
subject: Anti-Inflammatory Agents, Non-Steroidal
subject: Colitis, Ulcerative
subject: Cost-Benefit Analysis
subject: Costs and Cost Analysis
subject: Dosage Forms
subject: Humans
subject: Markov Chains
subject: Mesalamine
subject: Dewey Decimal Classification::600 | Technik::610 | Medizin, Gesundheit

description: Background: The treatment of ulcerative colitis (UC) can place a substantial financial burden on healthcare systems. The anti-inflammatory compound 5-aminosalicylic acid (5-ASA; mesalazine) is the recommended first-line treatment for patients with UC. In this analysis, the incremental cost effectiveness ratio (ICER) of two oral formulations of 5-ASA (Mezavant and Asacol) is examined in the treatment of patients with mild-to-moderate, active UC in Germany. Methods. A Markov cohort model was developed to assess the cost effectiveness of Mezavant compared with Asacol over a 5-year period in the German Statutory Health Insurance (SHI). Drug pricing details for 2009 were applied throughout the model, and overall resource use was determined and also fitted to 2009 from published results of a large cross sectional study of German SHI patients. Cost per quality adjusted life year (QALY) was the primary endpoint for this study. Remission rates were obtained using data from a randomised, phase III trial of Mezavant with an active Asacol reference arm and a long-term, open label, safety and tolerability trial of Mezavant. Uncertainty in the study model was assessed using one-way and probabilistic sensitivity analyses applying a Monte Carlo simulation. Results: Over a 5-year period, healthcare costs for patients receiving Mezavant were 624 Euro lower than for patients receiving Asacol. Additionally, patients receiving Mezavant gained 0.011 QALYs or 18 more days in remission compared with Asacol. One-way sensitivity analyses suggest that these results are driven by both differences in the acquisition cost between mesalazine formulations and differences in treatment efficacy. Furthermore, sensitivity analyses suggest a probability of 76% for cost savings and higher QALYs with Mezavant compared with Asacol. If adherence and its influence on the remission rates and the risk of developing colorectal cancer were included in the model, the results might have even been more favorable to Mezavant due to its once daily dosing regimen. Conclusions: This model suggests that patients treated with Mezavant may achieve increased time in remission and higher QALYs, with lower direct costs to the SHI when compared with Asacol. Mezavant may therefore be a suitable first-line option for the induction and maintenance of remission in UC.