title: Budesonide as first-line therapy for non-cirrhotic autoimmune hepatitis in children: a decision analysis.
abstract: OBJECTIVE
  Therapy for autoimmune hepatitis has been prednisone based for decades; however, budesonide may be equally effective with fewer side effects. Our aim was to evaluate quality-adjusted life years and health care costs of three different treatment regimens.
  
  
  METHODS
  Treatment using prednisone, budesonide or a combination of both over a three-year period in newly diagnosed children with type I autoimmune hepatitis were simulated with a Markov model. Transition probabilities were calculated over consecutive three-month period. Costs were determined from a hospital database and health utilities were estimated from the literature. A Monte Carlo probabilistic sensitivity analysis was used to simulate the outcomes of 5000 patients in each treatment arm.
  
  
  RESULTS
  Compared to standard therapy, budesonide leads to a gain of 0.09 quality-adjusted life years, costing $17,722 per QALY over a three-year period. Standard therapy led to significantly lower QALY's compared to other strategies (p < 0.001). Health utilities of patients in remission in each treatment group had the greatest impact on the model. Budesonide remained the treatment of choice if the probability of inducing remission was 55% or greater.
  
  
  CONCLUSIONS
  Budesonide therapy in non-cirrhotic, treatment naïve patients with type I autoimmune hepatitis yielded greater QALY's compared to the current standard therapy with an acceptable increase in costs.
authors.affiliation: a Department of Pediatrics , Feinberg School of Medicine, Northwestern University , 225 E Chicago Ave , Chicago , IL , USA.
authors.forename: Saeed
authors.initials: S
authors.lastname: Mohammad
mesh_terms: D000293:Adolescent; D000893:Anti-Inflammatory Agents / Q000191:economics / Q000627:therapeutic use*; D019819:Budesonide / Q000191:economics / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019693:Hepatitis, Autoimmune / Q000188:drug therapy* / Q000191:economics; D006801:Humans; D007087:Illinois; D008390:Markov Chains; D015122:Mercaptopurine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D009010:Monte Carlo Method; D011241:Prednisone / Q000191:economics / Q000627:therapeutic use; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; C488629:azathiopurine; D019819:Budesonide; D015122:Mercaptopurine; D011241:Prednisone
keywords: Cost–effectiveness; health utility; paediatrics; quality adjusted life years; side effects