title: Treating idiopathic pulmonary fibrosis with the addition of co-trimoxazole: an economic evaluation alongside a randomised controlled trial.
abstract: BACKGROUND
  Idiopathic pulmonary fibrosis (IPF) is a fibrotic disease of the lungs of unknown origin with a poor prognosis. A small trial of co-trimoxazole demonstrated improvements in symptoms and functional parameters over a 3-month period. We therefore conducted a larger trial with a concurrent economic evaluation to investigate this antibiotic further.
  
  
  METHODS
  We report an economic evaluation alongside a multi-centre, randomised, placebo-controlled, double-blind trial of 12 months therapy with 960 mg co-trimoxazole daily in 181 patients with fibrotic idiopathic interstitial pneumonia (IIP). Patients were recruited from 28 university and district hospitals in the UK and were aged over 40 years with fibrotic IIP. We report costs to the National Health Service (NHS) and society, change in forced vital capacity (primary endpoint) and quality-adjusted life-years (QALYs) gained, incremental cost effectiveness and cost utility ratios over 12 months.
  
  
  RESULTS
  From the perspective of society, mean cost per patient in the co-trimoxazole arm was approximately £1177 higher than in the placebo arm, but mean QALYs were 0.053 higher yielding an incremental cost-effectiveness ratio of £22,012 per QALY gained with a 54.44 % probability of being below £30,000. The cost of IPF to UK society in 2011 is tentatively estimated at £124 million, of which 13 % is NHS costs, 1 % social services, 2 % patient out-of-pocket costs and 84 % lost productivity.
  
  
  CONCLUSIONS
  Given commonly employed thresholds in the UK NHS, on balance co-trimoxazole may be a cost-effective treatment for IPF, although there is substantial decision uncertainty. However, recent guidance on the use of immunosuppressive therapy in IPF patients should be taken into account prior to any policy decision.
authors.affiliation: Health Economics Group, University of East Anglia, Norwich, NR4 7TJ, UK, ed.wilson@medschl.cam.ac.uk.
authors.forename: Edward C F
authors.initials: EC
authors.lastname: Wilson
authors.forename: Ludmila
authors.initials: L
authors.lastname: Shulgina
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Cahn
authors.forename: Edwin R
authors.initials: ER
authors.lastname: Chilvers
authors.forename: Helen
authors.initials: H
authors.lastname: Parfrey
authors.forename: Allan B
authors.initials: AB
authors.lastname: Clark
authors.forename: Orion P
authors.initials: OP
authors.lastname: Twentyman
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Wilson
mesh_terms: D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D017281:Cost of Illness; D003362:Cost-Benefit Analysis; D004311:Double-Blind Method; D016527:Drug Costs; D006801:Humans; D054990:Idiopathic Pulmonary Fibrosis / Q000188:drug therapy* / Q000191:economics*; D015337:Multicenter Studies as Topic; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000008:administration & dosage / Q000191:economics* / Q000627:therapeutic use; D035501:Uncertainty; D006113:United Kingdom
chemical_list: D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination