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Budesonide with multi-matrix technology (Budesonide MMX®) as second-line treatment for ulcerative colitis: evaluation of long-term cost-effectiveness in the Netherlands.

J Med Econ; : 1-24, 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29857775

AIMS:

Budesonide with multi-matrix technology (MMX) is an oral corticosteroid, shown to have high topical activity against ulcerative colitis (UC) while maintaining low systemic bioavailability with few adverse events. The aim of this study was to evaluate the cost-effectiveness of budesonide MMX versus commonly-used corticosteroids, in the second-line treatment of active mild-to-moderate UC in the Netherlands.

MATERIALS AND METHODS:

An 8-state Markov model with an 8-week cycle length captured remission, four distinct therapy stages, hospitalization, possible colectomy and mortality. Remission probability for budesonide MMX was based on the CORE-II study. Population characteristics were derived from the Dutch Inflammatory Bowel Disease South Limburg cohort (n = 598) and included patients with proctitis (39%), left-sided (42%) and extensive disease (19%). Comparators (topical budesonide foam and enema, oral budesonide and pre RESULTS: Budesonide MMX was associated with comparable QALY gain versus foam and oral formulations (+0.01 QALYs) in the total UC population, whilst being cost-saving (EUR 366 per patient). Probabilistic sensitivity analysis evaluated an 86.6% probability of budesonide MMX being dominant (cost-saving with QALY gain) versus these comparators. Exploratory analysis showed similar findings versus prednisolone.

LIMITATIONS:

Differing definitions of trial end-points and remission across trials meant indirect comparison was not ideal. However, in the absence of head-to-head clinical data, these comparisons are reasonable alternatives and currently offer the only comparison of second-line UC treatments.

CONCLUSIONS:

In the present analysis, budesonide MMX was shown to be cost-effective versus comparators in the total UC population, for the second-line treatment of active mild-to-moderate UC in the Netherlands.