Skip to main content

Advertisement

SpringerLink
Log in

Cost-effectiveness of febuxostat in chronic gout

  • Original Paper
  • Published:
The European Journal of Health Economics Aims and scope Submit manuscript

An Erratum to this article was published on 18 June 2014

Abstract

Our objective was to evaluate data on the cost-effectiveness of febuxostat compared with standard clinical practice with allopurinol in patients with gout that was presented to the Scottish Medicines Consortium (SMC) in 2010. A Markov health-state model estimated the direct health-related costs and clinical benefits expressed as quality-adjusted life-years (QALYs). Adults with chronic gout and established hyperuricaemia received treatment sequences of daily doses of allopurinol 300 mg alone or allopurinol 300 mg followed by febuxostat 80 mg/120 mg. The proportion of patients achieving the target serum uric acid (sUA) level of less than 6 mg/dl (0.36 mmol/l) was linked to the utility per sUA level to generate an incremental cost-effectiveness ratio (ICER). Second-line therapy with febuxostat 80 mg/120 mg versus with allopurinol alone resulted in an ICER of £3,578 per QALY over a 5-year time horizon. Additional univariate analyses showed that ICER values were robust and ranged from £2,550 to £7,165 per QALY when different parameters (e.g., low- and high-dose allopurinol titrations and variations in treatment-induced flare rates) were varied. Febuxostat reduces sUA below the European League Against Rheumatism target of 0.36 mmol/l (6 mg/dl) in significantly more patients with gout than allopurinol in its most frequently prescribed dose of 300 mg per day. The SMC accepted febuxostat as cost-effective as a suitable second-line option for urate-lowering therapy for the treatment of patients with chronic hyperuricaemia in conditions where urate deposition has already occurred (including a history or presence of tophus and/or gouty arthritis) when treatment with allopurinol was inadequate, not tolerated, or contraindicated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Roddy, E., Zhang, W., Doherty, M.: Is gout associated with reduced quality of life? A case-control study. Rheumatology (Oxford) 46, 1441–1444 (2007)

    Article  CAS  Google Scholar 

  2. Khanna, D., Ahmed, M., Yontz, D., et al.: The disutility of chronic gout. Qual. Life Res. 17, 815–822 (2008)

    Article  PubMed  Google Scholar 

  3. Singh, J.A., Strand, V.: Gout is associated with more comorbidities, poorer health-related quality of life and higher healthcare utilisation in US veterans. Ann. Rheum. Dis. 67, 1310–1316 (2008)

    Article  CAS  PubMed  Google Scholar 

  4. Becker, M.A., Schumacher, H.R., Benjamin, K.L., et al.: Quality of life and disability in patients with treatment-failure gout. J. Rheumatol. 36, 1041–1048 (2009)

    Article  PubMed  Google Scholar 

  5. Kleinman, N.L., Brook, R.A., Patel, P.A., et al.: The impact of gout on work absence and productivity. Value Health 10, 231–237 (2007)

    Article  PubMed  Google Scholar 

  6. Halpern, R., Fuldeore, M.J., Mody, R.R., et al.: The effect of serum urate on gout flares and their associated costs: an administrative claims analysis. J Clin Rheumatol 15(1), 3–7 (2009)

    Article  PubMed  Google Scholar 

  7. Wu, E.Q., Patel, P.A., Mody, R.R., et al.: Frequency, risk, and cost of gout-related episodes among the elderly: does serum uric acid level matter? J. Rheumatol. 36, 1032–1040 (2009)

    Article  PubMed  Google Scholar 

  8. Brook, R.A., Kleinman, N.L., Patel, P.A., et al.: The economic burden of gout on an employed population. Curr. Med. Res. Opin. 22, 1381–1389 (2006)

    Article  PubMed  Google Scholar 

  9. Wu, E.Q., Patel, P.A., Yu, A.P., et al.: Disease-related and all-cause health care costs of elderly patients with gout. J Manag Care Pharm. 14, 164–175 (2008)

    PubMed  Google Scholar 

  10. Hanly, J.G., Skedgel, C., Sketris, I., et al.: Gout in the elderly—a population health study. J. Rheumatol. 36, 822–830 (2009)

    Article  PubMed  Google Scholar 

  11. Annemans, L., Spaepen, E., Gaskin, M., et al.: Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000–2005. Ann. Rheum. Dis. 67, 960–966 (2008)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Mikuls, T.R., Farrar, J.T., Bilker, W.B., et al.: Gout epidemiology: results from the UK General Practice Research Database, 1990–1999. Ann. Rheum. Dis. 64, 267–272 (2005)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  13. Li-Yu, J., Clayburne, G., Sieck, M., et al.: Treatment of chronic gout. Can we determine when urate stores are depleted enough to prevent attacks of gout? J. Rheumatol. 28, 577–580 (2001)

    CAS  PubMed  Google Scholar 

  14. Shoji, A., Yamanaka, H., Kamatani, N.: A retrospective study of the relationship between serum urate level and recurrent attacks of gouty arthritis: evidence for reduction of recurrent gouty arthritis with antihyperuricemic therapy. Arthritis Rheum. 51, 321–325 (2004)

    Article  CAS  PubMed  Google Scholar 

  15. Perez-Ruiz, F.: Treating to target: a strategy to cure gout. Rheumatology (Oxford) 48(suppl 2), ii9–ii14 (2009)

    Article  CAS  Google Scholar 

  16. Zhang, W., Doherty, M., Bardin, T., et al.: EULAR evidence based recommendations for gout. Part II: management. Report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann. Rheum. Dis. 65, 1312–1324 (2006)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  17. Jordan, K.M., Cameron, J.S., Snaith, M., et al.: British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of gout. Rheumatology (Oxford) 46, 1372–1374 (2007)

    Article  Google Scholar 

  18. Cegedim Strategic Data UK Ltd.: Data on File. (2010)

  19. A. Menarini Pharma UK SRL: Adenuric Film-Coated Tablets. Summary of Product Characteristics. 12 May 2011. http://www.medicines.org.uk/emc/document.aspx?documentId=22830#CLINICAL_PARTS. Date last accessed 3 Nov 2011

  20. National Institute for Health and Clinical Excellence: Final Appraisal Determination. Febuxostat for the Management of Hyperuricaemia in People with Gout NICE. Aug 2008. http://www.nice.org.uk/nicemedia/live/11830/41648/41648.pdf. Date last accessed 3 Nov 2011

  21. Scottish Medicines Consortium: Febuxostat 80 mg and 120 mg Tablets (Adenuric®) SMC No. 637/10. 6 Aug 2010. http://www.scottishmedicines.org.uk/files/advice/febuxostat-Adenuric-FINAL-August-2010.pdf. Date last accessed 3 Nov 2011

  22. Schumacher Jr, H.R., Becker, M.A., Wortmann, R.L., et al.: Effects of febuxostat versus allopurinol and placebo in reducing serum urate in subjects with hyperuricemia and gout: a 28-week, phase III, randomized, double-blind, parallel-group trial. Arthritis Rheum. 59, 1540–1548 (2008)

    Article  CAS  PubMed  Google Scholar 

  23. Becker, M.A., Schumacher Jr, H.R., Wortmann, R.L., et al.: Febuxostat compared with allopurinol in patients with hyperuricemia and gout. N. Engl. J. Med. 353, 2450–2461 (2005)

    Article  CAS  PubMed  Google Scholar 

  24. Becker, M.A., Schumacher, H.R., MacDonald, P.A., et al.: Clinical efficacy and safety of successful long-term urate lowering with febuxostat or allopurinol in subjects with gout. J. Rheumatol. 36, 1273–1282 (2009)

    Article  CAS  PubMed  Google Scholar 

  25. Becker, M.A., Schumacher, H.R., Espinoza, L.R., et al.: The urate-lowering efficacy and safety of febuxostat in the treatment of the hyperuricemia of gout: the CONFIRMS trial. Arthritis Res Ther 12, R63 (2010). doi:10.1186/ar2978

    Article  PubMed Central  PubMed  Google Scholar 

  26. Schumacher Jr, H.R., Becker, M.A., Lloyd, E., et al.: Febuxostat in the treatment of gout: 5-yr findings of the FOCUS efficacy and safety study. Rheumatology (Oxford) 48, 188–194 (2009)

    Article  CAS  Google Scholar 

  27. Becker, M.A., Schumacher Jr, H.R., Wortmann, R.L., et al.: Febuxostat, a novel nonpurine selective inhibitor of xanthine oxidase: a twenty-eight-day, multicenter, phase II, randomized, double-blind, placebo-controlled, dose-response clinical trial examining safety and efficacy in patients with gout. Arthritis Rheum. 52, 916–923 (2005)

    Article  CAS  PubMed  Google Scholar 

  28. Ipsen, U.K.: Integrated Summary of Efficacy. Data on File. (2005)

  29. Institute of Medical Science World Publications Ltd: A Health Economic Assessment of Febuxostat in the Management of Gout. Data on File. Version No. 1.0, 19 Oct 2007

  30. BMJ Publishing Group Ltd., RCPCH Publications Ltd., Royal Pharmaceutical Society of Great Britain: British National Formulary. http://bnf.org/bnf/bnf/current/index.htm. (2011)

  31. Office for National Statistics: Mortality Statistics. Deaths Registered in 2007

  32. Scottish Medicines Consortium: Guidance to Manufacturers for Completion of New Product Assessment Form (NPAF). June 2011. http://www.scottishmedicines.org.uk/files/submissionprocess/New_Product_Assessment_Form_NPAF_Guidance_Notes_updated_February_2011_Final.doc. Date last accessed 3 Nov 2011

  33. Roddy, E., Zhang, W., Doherty, M.: Concordance of the management of chronic gout in a UK primary-care population with the EULAR gout recommendations. Ann. Rheum. Dis. 66, 1311–1315 (2007)

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  34. National Institute for Health and Clinical Excellence: Guide to the Methods of Technology Appraisal. June 2008. http://www.nice.org.uk/media/B52/A7/TAMethodsGuideUpdatedJune2008.pdf Date last accessed 3 Nov 2011

  35. Borstad, G.C., Bryant, L.R., Abel, M.P., et al.: Colchicine for prophylaxis of acute flares when initiating allopurinol for chronic gouty arthritis. J. Rheumatol. 31(12), 2429–2432 (2004)

    CAS  PubMed  Google Scholar 

  36. Ipsen, U.K.: Febuxostat for the Treatment of Gout Single Technology Appraisal Submission to the National Institute for Health and Clinical Excellence. 14 May 2008. http://www.nice.org.uk/nicemedia/live/11830/40731/40731.pdf. Date last accessed 3 Nov 2011

  37. Jackson, T.: Cost Analysis of Febuxostat Versus Allopurinol for Prophylaxis of Gout Flares. In: Poster presented at the 17th Annual International Meeting of the International Society for Pharmacoeconomics and Outcomes Research. Washington, DC, June 2–6 2012

  38. Jutkowitz, E., Pizzi, L., Meltzer, M.: Comparison of cost of allopurinol vs febuxostat as a first line treatment for gout. Value Health 13(3), A123 (2010)

    Article  Google Scholar 

  39. Pandya, B.J., Quimbo, R.A., Mody, R., et al.: Budgetary impact of a new urate-lowering therapy (ULT) for the treatment of gout in a US health plan formulary. Value Health 12(7), A435 (2009)

    Article  Google Scholar 

  40. Rashid, N., Hay, J.W.: Cost effectiveness analysis of managing chronic gout with febuxostat (Uloric) versus allopurinol (Zyloprim). Value Health 13(3), A126 (2010)

    Article  Google Scholar 

  41. Redding, L., Hornberger, J., Cowens, W., et al.: Cost-effectiveness of febuxostat in managing hyperuricemia in gout patients in Canada. J Popul Ther Clin Pharmacol 18(2), e195–e196 (2011)

    Google Scholar 

  42. Stevenson, M., Pandor, A.: Hyperuricaemia—febuxostat: Evidence Review Group Report. Febuxostat for the Management of Hyperuricaemia in Patients with Gout. 31 March 2008. http://www.nice.org.uk/nicemedia/live/11830/40721/40721.pdf. Date last accessed 3 Nov 2011

  43. Stevenson, M., Pandor, A.: Febuxostat for the treatment of hyperuricaemia in people with gout: a single technology appraisal. Health Technol. Assess. 13(suppl 3), 37–42 (2009). http://www.hta.ac.uk/erg/supplements/supplement1303.pdf#nameddest=article06. Date last accessed 3 Nov 2011

  44. Stevenson, M., Pandor, A.: Febuxostat for the management of hyperuricaemia in patients with gout: a NICE single technology appraisal. Pharmacoeconomics 29(2), 133–140 (2011). http://www.ncbi.nlm.nih.gov/pubmed/21155617. Date last accessed 3 Nov 2011

  45. Reinders, M.K., Haagsma, C., Jansen, T.L., et al.: A randomised controlled trial on the efficacy and tolerability with dose escalation of allopurinol 300–600 mg/day versus benzbromarone 100–200 mg/day in patients with gout. Ann. Rheum. Dis. 68, 892–897 (2009)

    Article  CAS  PubMed  Google Scholar 

  46. Lee, S.J., Hirsch, J.D., Terkeltaub, R., et al.: Perceptions of disease and health-related quality of life among patients with gout. Rheumatology (Oxford) 48, 582–586 (2009)

    Article  Google Scholar 

  47. van Groen, M.M., ten Klooster, P.M., Taal, E., et al.: Application of the health assessment questionnaire disability index to various rheumatic diseases. Qual. Life Res. 19, 1255–1263 (2010)

    Article  PubMed Central  PubMed  Google Scholar 

  48. Dalbeth, N., Collis, J., Gregory, K., et al.: Tophaceous joint disease strongly predicts hand function in patients with gout. Rheumatology (Oxford) 46, 1804–1807 (2007)

    Article  CAS  Google Scholar 

  49. Teng, G.G., Nair, R., Saag, K.G.: Pathophysiology, clinical presentation and treatment of gout. Drugs 66, 1547–1563 (2006)

    Article  CAS  PubMed  Google Scholar 

  50. Niskanen, L.K., Laaksonen, D.E., Nyyssonen, K., et al.: Uric acid level as a risk factor for cardiovascular and all-cause mortality in middle-aged men: a prospective cohort study. Arch. Intern. Med. 164, 1546–1551 (2004)

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The model development was performed by RTI Health Solutions. The authors were responsible for the content and developing the manuscript. SB, BvS, and IP have received support from Menarini International O.L. SA for the submitted work, and GN was employed as an advisory consultant in connection with the febuxostat submission for new product assessment to the Scottish Medicines Consortium.

Author information

Authors and Affiliations

  1. RTI Health Solutions, Sheffield, UK

    Stephen M. Beard

  2. RTI Health Solutions, Lund, Sweden

    Birgitta G. von Scheele

  3. Institute of Genetics and Molecular Medicine, University of Edinburgh, Western General Hospital, Edinburgh, UK

    George Nuki

  4. RTI Health Solutions, 2nd Floor, The Pavilion Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, UK

    Isobel V. Pearson

Authors
  1. Stephen M. Beard
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Birgitta G. von Scheele
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. George Nuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Isobel V. Pearson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Isobel V. Pearson.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Beard, S.M., von Scheele, B.G., Nuki, G. et al. Cost-effectiveness of febuxostat in chronic gout. Eur J Health Econ 15, 453–463 (2014). https://doi.org/10.1007/s10198-013-0486-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10198-013-0486-z

Keywords

JEL Classification

Search

Navigation