A cost-effectiveness analysis of MMX mesalazine compared with mesalazine in the treatment of mild-to-moderate ulcerative colitis from a UK perspective.
OBJECTIVE
To perform a cost-utility analysis of a new formulation of mesalazine (Mezavant XL, MMX mesalazine) versus an existing oral mesalazine (Asacol; mesalazine) from the UK National Health Service perspective.


METHODS
A 5-year Markov cohort model was developed. Costs were obtained from the literature and utilities from an independent study. Uncertainty was evaluated using one-way and probabilistic sensitivity analyses (PSA). The potential effect of dosing frequency on adherence and possible long-term effects of remission maintenance on colorectal cancer (CRC) rates were also investigated.


RESULTS
The model suggested that 5-year therapy with MMX mesalazine was likely to generate gains when compared with mesalazine, including a gain of 0.011 QALYs per patient, 19 more remission days, and 12% fewer hospitalizations and surgical episodes. These gains came at an increase in total NHS direct cost of £8, resulting in an incremental cost-effectiveness ratio (ICER) of £749. The PSA suggested that MMX mesalazine had a 62% chance of resulting in cost savings, and a 74% chance of being cost-effective (£20,000 threshold). Extended analysis including adherence and CRC effects suggested further incremental benefit of MMX mesalazine over mesalazine could be expected. Limitations include uncertainty in extrapolation to a 5-year time horizon and impact of adherence and drug acquisition costs on outcomes.


CONCLUSIONS
The pharmacoeconomic analysis suggested that MMX mesalazine is likely to produce small, but worthwhile, increases in total NHS direct cost while increasing time in remission and associated quality of life, when compared with mesalazine. Advantages in adherence to treatment with MMX mesalazine relative to mesalazine suggested that further health gains and cost savings can be obtained. Overall, these results suggest that MMX mesalazine is a cost-effective treatment for UC.
Brereton
Nic
N
School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, UK. nbrereton@bresmed.co.uk
Bodger
Keith
K
Kamm
Michael A
MA
Hodgkins
Paul
P
Yan
Songkai
S
Akehurst
Ron
R
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000191:economics* / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000191:economics* / Q000523:psychology; D016001:Confidence Intervals; D003362:Cost-Benefit Analysis; D017850:Economics, Pharmaceutical; D006305:Health Status Indicators; D006801:Humans; D008390:Markov Chains; D019804:Mesalamine / Q000191:economics* / Q000627:therapeutic use; D018803:Models, Economic; D015233:Models, Statistical; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D013995:Time; D035501:Uncertainty; D006113:United Kingdom
D000894:Anti-Inflammatory Agents, Non-Steroidal; D019804:Mesalamine