title: Cost-effectiveness of allopurinol and febuxostat for the management of gout.
abstract: BACKGROUND
  Gout is the most common inflammatory arthritis in the United States.
  
  
  OBJECTIVE
  To evaluate the cost-effectiveness of urate-lowering treatment strategies for the management of gout.
  
  
  METHODS
  Markov model.
  
  
  METHODS
  Published literature and expert opinion.
  
  
  METHODS
  Patients for whom allopurinol or febuxostat is a suitable initial urate-lowering treatment.
  
  
  METHODS
  Lifetime.
  
  
  CONCLUSIONS
  Health care payer.
  
  
  METHODS
  5 urate-lowering treatment strategies were evaluated: no treatment; allopurinol- or febuxostat-only therapy; allopurinol-febuxostat sequential therapy; and febuxostat-allopurinol sequential therapy. Two dosing scenarios were investigated: fixed dose (80 mg of febuxostat daily, 0.80 success rate; 300 mg of allopurinol daily, 0.39 success rate) and dose escalation (≤120 mg of febuxostat daily, 0.82 success rate; ≤800 mg of allopurinol daily, 0.78 success rate).
  
  
  METHODS
  Discounted costs, discounted quality-adjusted life-years, and incremental cost-effectiveness ratios.
  
  
  RESULTS
  In both dosing scenarios, allopurinol-only therapy was cost-saving. Dose-escalation allopurinol-febuxostat sequential therapy was more costly but more effective than dose-escalation allopurinol therapy, with an incremental cost-effectiveness ratio of $39 400 per quality-adjusted life-year.
  
  
  RESULTS
  The relative rankings of treatments did not change. Our results were relatively sensitive to several potential variations of model assumptions; however, the cost-effectiveness ratios of dose escalation with allopurinol-febuxostat sequential therapy remained lower than the willingness-to-pay threshold of $109 000 per quality-adjusted life-year.
  
  
  CONCLUSIONS
  Long-term outcome data for patients with gout, including medication adherence, are limited.
  
  
  CONCLUSIONS
  Allopurinol single therapy is cost-saving compared with no treatment. Dose-escalation allopurinol-febuxostat sequential therapy is cost-effective compared with accepted willingness-to-pay thresholds.
  
  
  BACKGROUND
  Agency for Healthcare Research and Quality.
authors.forename: Eric
authors.initials: E
authors.lastname: Jutkowitz
authors.forename: Hyon K
authors.initials: HK
authors.lastname: Choi
authors.forename: Laura T
authors.initials: LT
authors.lastname: Pizzi
authors.forename: Karen M
authors.initials: KM
authors.lastname: Kuntz
mesh_terms: D000493:Allopurinol / Q000008:administration & dosage / Q000191:economics*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination / Q000191:economics; D000069465:Febuxostat; D006073:Gout / Q000188:drug therapy* / Q000191:economics; D006074:Gout Suppressants / Q000008:administration & dosage / Q000191:economics*; D006801:Humans; D008390:Markov Chains; D008962:Models, Theoretical; D019057:Quality-Adjusted Life Years; D013844:Thiazoles / Q000008:administration & dosage / Q000191:economics*
chemical_list: D006074:Gout Suppressants; D013844:Thiazoles; D000069465:Febuxostat; D000493:Allopurinol