THU0048 2ND LINE TREATMENT WITH LESINURAD AND ALLOPURINOL VERSUS FEBUXOSTAT FOR MANAGEMENT OF HYPERURICEMIA: A COST-EFFECTIVENESS ANALYSIS FOR SPANISH PATIENTS
Authors: María Presa, Fernando Perez-Ruiz, Itziar Oyagüez
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background</h3> Lesinurad, a medication that inhibits uric acid reabsorption, has been recently approved in combination for the treatment of patients with gout which do not reach therapeutic serum urate target with xanthineoxidase inhibitors monotherapy <h3>Objectives</h3> To assess the incremental cost-effectiveness ratio of adding lesinurad to allopurinol as 2<sup>nd</sup> line therapy, compared to febuxostat for the management of patients with gout in Spain. <h3>Methods</h3> A Markov model comprising 6 health-states representing the disease evolution was used to estimate in 6-months cycles, the lifetime accumulated cost and benefits in terms of quality-adjusted-life-year (QALY) in an hypothetical cohort of patients stratified according to serum uric acid levels observed on pooled CLEAR trials: 18.8% (&lt;6 mg/dL); 63.7% (6-8 mg/dL); 15.2% (8-10 mg/dL) and 2.3% (≥10 mg/dL). During the simulation, patients could either continue with 2<sup>nd</sup> line treatment with lesinurad (200mg/daily) plus allopurinol (400mg/daily) or febuxostat (80mg/daily), switch to allopurinol monotherapy (271mg/daily) in case of intolerance or discontinue treatment. Proportion of tophaceous gout (18.9%) was considered at each health-state. The efficacy of treatments was captured in the transition probabilities between health states which were derived from findings on CLEAR 1, CLEAR 2 and EXCEL clinical trials. Quality of life related to gout severity (tophaceous or non-tophaceous) and flare frequency was considered by means of utilities estimated from SF-36 scores of the pooled CLEAR trials which were mapped to EQ-5D values. The total cost estimation (€, 2018) included drug acquisition cost (retail prices with mandatory deduction applied), disease monitoring (€377.03 for first 6-month period, €329.95/subsequent year) and flare management cost (€301.69). Unitary costs derived from local cost databases and literature. A 3% annual discount rate was applied for cost and outcomes. Sensitivity analyses (SA) were carried out. <h3>Results</h3> Lesinurad added to allopurinol provided higher QALYs (14.79) than febuxostat (14.69). Total accrued cost per patient were lower (€-6,819.13) with lesinurad and allopurinol (€49,659.27) compared to febuxostat (€56,478.40). Lesinurad plus allopurinol resulted a dominant option (more effective and less costly) compared to febuxostat. SA results confirmed the model robustness. <h3>Conclusion</h3> These results suggest that treatment with lesinurad 200 mg/day plus allopurinol 400 mg/day compared to febuxostat 80 mg/day is an effective second option for the management of hyperuricemia in patients with gout who did not reach therapeutic srum urate target to previous allopurinol monotherapy, associated to cost-savings for the Spanish National Health System. <h3>References</h3> [1] Bardin T, et al. Ann Rheum Dis. 2017;76:811-20. [2] Becker MA, et al. J Rheumatol. 2009;36:1273-82. [3] Pérez-Ruiz F, et al. J Med Econ. 2016;19:604-10. [4] Saag K, et al. Arthritis Rheumatol. 2017;69:203-12. <h3>Disclosure of Interests</h3> María Presa Consultant for: I am employee of PORIB a consultant company which has received financial support from Grünenthal for development of this project, Fernando Perez-Ruiz Grant/research support from: Cruces Rheumatology Association, Consultant for: Grunenthal, Menarini, Horizon, Speakers bureau: Menarini, Grunenthal; Spanish foundation for rheumatology, Itziar Oyagüez Consultant for: I am employee of PORIB a consultant company which has received financial support from Grünenthal for development of this project