The cost-effectiveness of mycophenolate mofetil as firstline therapy in active lupus nephritis.
OBJECTIVE
Systemic lupus erythematosus (SLE) is an autoimmune disorder that can affect any system of the body. Involvement of the kidneys, lupus nephritis (LN), affects up to 50% of SLE patients during the course of their disease, and is characterized by periods of active disease (flares) and remission. For more severe nephritis, an induction course of immunosuppressive therapy is recommended. Options include intravenous cyclophosphamide (IVC) or mycophenolate mofetil (MMF), followed by a maintenance course, typically of azathioprine. The objective of this study is to determine which therapy results in better quality of life (QoL) for patients and which represents best value for money for finite health service resources.


METHODS
A patient-level simulation model is developed to estimate the costs and quality-adjusted life-years (QALYs) of a patient treated with IVC or MMF for an induction period of six months. Efficacy, QoL, resource use and cost data are extracted from the literature and standard databases and supplemented with expert opinion where necessary.


RESULTS
On average, the model predicts MMF to result in improved QoL compared with IVC. MMF is also less expensive than IVC, costing pound 1600 (euro 2400; US$ 3100) less over the period, based on 2005 NHS prices. The major determinant and cost driver of this result is the requirement for a day-case procedure to administer IVC. Sensitivity analysis shows an 81% probability that MMF will be cost-effective compared with IVC at a willingness to pay of pound 30,000 (euro 44,700; US$ 58,500) per QALY gained.


CONCLUSIONS
MMF is likely to result in better QoL and be less expensive than IVC as induction therapy for LN.
Wilson
E C F
EC
Health Economics Group, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich NR4 7TJ, UK. ed.wilson@uea.ac.uk
Jayne
D R W
DR
Dellow
E
E
Fordham
R J
RJ
D000208:Acute Disease; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use; D003631:Day Care, Medical / Q000191:economics; D016527:Drug Costs; D006801:Humans; D007166:Immunosuppressive Agents / Q000191:economics* / Q000627:therapeutic use; D007262:Infusions, Intravenous; D008180:Lupus Erythematosus, Systemic / Q000188:drug therapy; D008181:Lupus Nephritis / Q000188:drug therapy*; D018803:Models, Economic; D009173:Mycophenolic Acid / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use; D011239:Prednisolone / Q000191:economics* / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D013222:State Medicine / Q000191:economics
D007166:Immunosuppressive Agents; D003520:Cyclophosphamide; D011239:Prednisolone; D009173:Mycophenolic Acid