title: Cost-effectiveness of linaclotide compared to antidepressants in the treatment of irritable bowel syndrome with constipation in Scotland.
abstract: Presently, linaclotide is the only EMA-approved therapy indicated for the treatment of irritable bowel syndrome with constipation (IBS-C). This study sought to determine the cost-effectiveness of linaclotide compared to antidepressants for the treatment of adults with moderate to severe IBS-C who have previously received antispasmodics and/or laxatives. A Markov model was created to estimate costs and QALYs over a 5-year time horizon from the perspective of NHS Scotland. Health states were based on treatment satisfaction (satisfied, moderately satisfied, not satisfied) and mortality. Transition probabilities were based on satisfaction data from the linaclotide pivotal studies and Scottish general all-cause mortality statistics. Treatment costs were calculated from the British National Formulary. NHS resource use and disease-related costs for each health state were estimated from Scottish clinician interviews in combination with NHS Reference costs. Quality of life was based on EQ-5D data collected from the pivotal studies. Costs and QALYs were discounted at 3.5 % per annum. Uncertainty was explored through extensive deterministic and probabilistic sensitivity analyses. Over a 5-year time horizon, the additional costs and QALYs generated with linaclotide were £659 and 0.089, resulting in an incremental cost-effectiveness ratio of £7370 per QALY versus antidepressants. Based on the probabilistic sensitivity analysis, the likelihood that linaclotide was cost-effective at a willingness to pay of £20,000 per QALY was 73 %. Linaclotide can be a cost-effective treatment for adults with moderate-to-severe IBS-C who have previously received antispasmodics and/or laxatives in Scotland.
authors.affiliation: WG Consulting Healthcare Limited, High Wycombe, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Fisher
authors.affiliation: Glasgow University, Glasgow, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Walker
authors.affiliation: Almirall S.A., General Mitre, 151, 08022, Barcelona, Spain.
authors.forename: Meritxell
authors.initials: M
authors.lastname: Falqués
authors.affiliation: Almirall S.A., General Mitre, 151, 08022, Barcelona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Moya
authors.affiliation: Almirall Ltd., London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Rance
authors.affiliation: Ironwood Pharmaceuticals, Cambridge, MA, USA.
authors.forename: Douglas
authors.initials: D
authors.lastname: Taylor
authors.affiliation: Almirall S.A., General Mitre, 151, 08022, Barcelona, Spain. leandro.lindner@almirall.com.
authors.forename: Leandro
authors.initials: L
authors.lastname: Lindner
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000191:economics* / Q000627:therapeutic use; D002423:Cause of Death; D003248:Constipation / Q000150:complications; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006801:Humans; D043183:Irritable Bowel Syndrome / Q000150:complications / Q000188:drug therapy* / Q000191:economics* / Q000523:psychology; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D017060:Patient Satisfaction; D010455:Peptides / Q000191:economics* / Q000627:therapeutic use; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D016032:Randomized Controlled Trials as Topic; D012606:Scotland / Q000453:epidemiology; D018434:Sickness Impact Profile; D013222:State Medicine; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents; D010455:Peptides; C523483:linaclotide
keywords: Constipation; Cost-effectiveness analysis; Irritable bowel syndrome; Linaclotide