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Cost-effectiveness of tacrolimus ointment vs. standard treatment in patients with moderate and severe atopic dermatitis: a health-economic model simulation based on a patient survey and clinical trial data.

Hjelmgren, J; Svensson, Åke LU ; Jörgensen, E T; Lindemalm Lundstam, B and Ragnarson Tennvall, G (2007) In British Journal of Dermatology 156. p.913-921
Abstract
Background Atopic dermatitis (AD) affects health and quality of life (QoL) and also has great impact on both healthcare costs and costs to society. Objectives The aim of the study was to analyse the cost-effectiveness of treatment with tacrolimus ointment vs. standard treatment in patients with moderate to severe AD. Methods A Markov simulation model was constructed capturing several key features of AD and its treatment: disease severity, treatment alternatives, and QoL. The model was populated with data from three sources: (i) efficacy data from a randomized controlled trial including patients with moderate to severe AD treated with either tacrolimus ointment or standard treatment (corticosteroids), (ii) resource utilization and QoL data... (More)
Background Atopic dermatitis (AD) affects health and quality of life (QoL) and also has great impact on both healthcare costs and costs to society. Objectives The aim of the study was to analyse the cost-effectiveness of treatment with tacrolimus ointment vs. standard treatment in patients with moderate to severe AD. Methods A Markov simulation model was constructed capturing several key features of AD and its treatment: disease severity, treatment alternatives, and QoL. The model was populated with data from three sources: (i) efficacy data from a randomized controlled trial including patients with moderate to severe AD treated with either tacrolimus ointment or standard treatment (corticosteroids), (ii) resource utilization and QoL data from a patient survey including 161 Swedish patients with AD, and (iii) official price lists. Costs were calculated according to disease severity for the two treatment alternatives using the perspective of the Swedish healthcare sector. Two analyses were performed, one based on the quantity of medication used in the trial and one based on the survey data. The relationship between effectiveness of tacrolimus ointment and the amount of medication used was tested in sensitivity analyses. Results In the model simulations patients with severe AD treated with tacrolimus ointment experienced on average 4.6 more AD-free weeks per year than patients given standard treatment. The corresponding figure for patients with moderate AD was 6.5 more AD-free weeks per year. The cost-effectiveness ratios [cost per Quality Adjusted Life Year (QALY) gained] for treatment with tacrolimus ointment vs. standard treatment were 2334 pound for moderate AD and 3875 pound for severe AD when treatment patterns from the survey were assumed, and 8269 pound for moderate AD and 12 pound 304 for severe AD when treatment patterns from the clinical trial were assumed. The results of sensitivity analyses were all well within limits to be considered cost-effective. Conclusions Estimates of the incremental cost-effectiveness ratio are far below the currently discussed threshold in Sweden, corresponding to approximately 48 pound 700 per QALY gained, and equivalent thresholds in other countries. Treatment with tacrolimus ointment in patients with moderate and severe AD can therefore be considered cost-effective. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
tacrolimus, ointment, model simulation, atopic dermatitis, cost-effectiveness
in
British Journal of Dermatology
volume
156
pages
913 - 921
publisher
Wiley-Blackwell
external identifiers
  • wos:000245938700016
  • scopus:34247325180
ISSN
1365-2133
DOI
10.1111/j.1365-2133.2006.07707.x
language
English
LU publication?
yes
id
9cce7272-6379-421b-afd6-18c6f13e8b32 (old id 166030)
alternative location
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=17263826&dopt=Abstract
date added to LUP
2007-07-23 16:09:51
date last changed
2017-06-04 03:39:18
@article{9cce7272-6379-421b-afd6-18c6f13e8b32,
  abstract     = {Background Atopic dermatitis (AD) affects health and quality of life (QoL) and also has great impact on both healthcare costs and costs to society. Objectives The aim of the study was to analyse the cost-effectiveness of treatment with tacrolimus ointment vs. standard treatment in patients with moderate to severe AD. Methods A Markov simulation model was constructed capturing several key features of AD and its treatment: disease severity, treatment alternatives, and QoL. The model was populated with data from three sources: (i) efficacy data from a randomized controlled trial including patients with moderate to severe AD treated with either tacrolimus ointment or standard treatment (corticosteroids), (ii) resource utilization and QoL data from a patient survey including 161 Swedish patients with AD, and (iii) official price lists. Costs were calculated according to disease severity for the two treatment alternatives using the perspective of the Swedish healthcare sector. Two analyses were performed, one based on the quantity of medication used in the trial and one based on the survey data. The relationship between effectiveness of tacrolimus ointment and the amount of medication used was tested in sensitivity analyses. Results In the model simulations patients with severe AD treated with tacrolimus ointment experienced on average 4.6 more AD-free weeks per year than patients given standard treatment. The corresponding figure for patients with moderate AD was 6.5 more AD-free weeks per year. The cost-effectiveness ratios [cost per Quality Adjusted Life Year (QALY) gained] for treatment with tacrolimus ointment vs. standard treatment were 2334 pound for moderate AD and 3875 pound for severe AD when treatment patterns from the survey were assumed, and 8269 pound for moderate AD and 12 pound 304 for severe AD when treatment patterns from the clinical trial were assumed. The results of sensitivity analyses were all well within limits to be considered cost-effective. Conclusions Estimates of the incremental cost-effectiveness ratio are far below the currently discussed threshold in Sweden, corresponding to approximately 48 pound 700 per QALY gained, and equivalent thresholds in other countries. Treatment with tacrolimus ointment in patients with moderate and severe AD can therefore be considered cost-effective.},
  author       = {Hjelmgren, J and Svensson, Åke and Jörgensen, E T and Lindemalm Lundstam, B and Ragnarson Tennvall, G},
  issn         = {1365-2133},
  keyword      = {tacrolimus,ointment,model simulation,atopic dermatitis,cost-effectiveness},
  language     = {eng},
  pages        = {913--921},
  publisher    = {Wiley-Blackwell},
  series       = {British Journal of Dermatology},
  title        = {Cost-effectiveness of tacrolimus ointment vs. standard treatment in patients with moderate and severe atopic dermatitis: a health-economic model simulation based on a patient survey and clinical trial data.},
  url          = {http://dx.doi.org/10.1111/j.1365-2133.2006.07707.x},
  volume       = {156},
  year         = {2007},
}