Pioglitazone and vitamin E for nonalcoholic steatohepatitis: a cost utility analysis.
Nonalcoholic steatohepatitis (NASH) is the commonest liver disease in developed countries. However, there are no current data on the cost-effectiveness of therapeutic options such as lifestyle modification, pioglitazone, or vitamin E. We undertook a cost utility analysis to compare these strategies. Using a third-party payer perspective, a deterministic Markov model was developed to compare costs and health benefits of lifestyle modification alone or with pioglitazone or vitamin E in a cohort of patients aged 50 years with biopsy-proven NASH and fibrosis level 3 or greater. We assumed an annual cycle length over a lifetime horizon. Probability and utility estimates were derived from a systematic literature review, and uncertainties in parameter estimates were tested using one- and two-way sensitivity analyses. Our outcome measure was the incremental cost-effectiveness ratio (ICER), with $A50,000 or less considered cost-effective. In comparison with lifestyle modification alone, treatment with either pioglitazone or vitamin E in addition to lifestyle modification was cost-effective, with incremental cost-effectiveness ratios of $A2748 and $A8475 per quality-adjusted life year (QALY) gained, respectively. In a direct comparison, pioglitazone was more cost-effective than vitamin E (ICER $A2,056/QALY gained). Sensitivity analyses indicated that pioglitazone was not cost-effective if either the total drug cost was greater than $A16,000 per annum, or the annual probability of developing cirrhosis in advanced fibrosis was less than 2%.


CONCLUSIONS
Our modeled analyses suggest that in patients with advanced fibrosis due to NASH, pharmacological treatment in addition to standard lifestyle modification is likely to be cost-effective.
School of Public Health, University of Sydney, Sydney, Australia. suzanne.mahady@sydney.edu.au
Suzanne E
SE
Mahady
Germaine
G
Wong
Jonathan C
JC
Craig
Jacob
J
George
D003131:Combined Modality Therapy / Q000191:economics; D003362:Cost-Benefit Analysis; D005234:Fatty Liver / Q000150:complications / Q000191:economics* / Q000628:therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics* / Q000627:therapeutic use; D008019:Life Style; D008103:Liver Cirrhosis / Q000191:economics / Q000209:etiology / Q000473:pathology; D008390:Markov Chains; D065626:Non-alcoholic Fatty Liver Disease; D000077205:Pioglitazone; D019057:Quality-Adjusted Life Years; D012720:Severity of Illness Index; D045162:Thiazolidinediones / Q000191:economics* / Q000627:therapeutic use; D014810:Vitamin E / Q000191:economics* / Q000627:therapeutic use; D014815:Vitamins / Q000191:economics* / Q000627:therapeutic use
D007004:Hypoglycemic Agents; D045162:Thiazolidinediones; D014815:Vitamins; D014810:Vitamin E; D000077205:Pioglitazone