Doxycycline compared with prednisolone therapy for patients with bullous pemphigoid: cost-effectiveness analysis of the BLISTER trial
| Autor: | Mason, James, Chalmers, J. R., Godec, T., Nunn, A. J., Kirtschig, G., Wojnarowska, F., Childs, M., Whitham, D., Schmidt, E., Harman, K, Walton, S., Chapman, A., Williams, H. C., HASH(0x5651c9c4bd50) |
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| Rok vydání: | 2017 |
| Předmět: |
Male
medicine.medical_specialty Pemphigoid Cost-Benefit Analysis Health Status Prednisolone RL Dermatology law.invention 030207 dermatology & venereal diseases 03 medical and health sciences 0302 clinical medicine Quality of life Randomized controlled trial law Internal medicine Pemphigoid Bullous medicine Humans skin and connective tissue diseases Aged Doxycycline integumentary system business.industry 030503 health policy & services Cost-effectiveness analysis medicine.disease Quality-adjusted life year Treatment Outcome Quality of Life Female Bullous pemphigoid Dermatologic Agents Quality-Adjusted Life Years 0305 other medical science business medicine.drug |
| Zdroj: | The British journal of dermatology. 178(2) |
| ISSN: | 1365-2133 0007-0963 |
| Popis: | Bullous pemphigoid (BP) is an autoimmune blistering skin disorder associated with significant morbidity and mortality. Doxycycline and prednisolone to treat bullous pemphigoid were compared within a randomized controlled trial (RCT).To compare the cost-effectiveness of doxycycline-initiated and prednisolone-initiated treatment for patients with BP.Quality-of-life (EuroQoL-5D-3L) and resource data were collected as part of the BLISTER trial: a multicentre, parallel-group, investigator-blinded RCT. Within-trial analysis was performed using bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective.In the base case, there was no robust difference in costs or QALYs per patient at 1 year comparing doxycycline- with prednisolone-initiated therapy [net cost £959, 95% confidence interval (CI) -£24 to £1941; net QALYs -0·024, 95% CI -0·088 to 0·041]. However, the findings varied by baseline blister severity. For patients with mild or moderate blistering (≤ 30 blisters) net costs and outcomes were similar. For patients with severe blistering (30 blisters) net costs were higher (£2558, 95% CI -£82 to £5198) and quality of life poorer (-0·090 QALYs, 95% CI -0·22 to 0·042) for patients starting on doxycycline. The probability that doxycycline would be cost-effective for those with severe pemphigoid was 1·5% at a willingness to pay of £20 000 per QALY.Consistently with the clinical findings of the BLISTER trial, patients with mild or moderate blistering should receive treatment guided by the safety and effectiveness of the drugs and patient preference - neither strategy is clearly a preferred use of National Health Service resources. However, prednisolone-initiated treatment may be more cost-effective for patients with severe blistering. |
| Databáze: | OpenAIRE |
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