title: Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis.
abstract: OBJECTIVE
  Topical corticosteroids or dietary elimination are recommended as first-line therapies for eosinophilic esophagitis, but data to directly compare these therapies are scant. We performed a cost utility comparison of topical corticosteroids and the 6-food elimination diet (SFED) in treatment of eosinophilic esophagitis, from the payer perspective.
  
  
  METHODS
  We used a modified Markov model based on current clinical guidelines, in which transition between states depended on histologic response simulated at the individual cohort-member level. Simulation parameters were defined by systematic review and meta-analysis to determine the base-case estimates and bounds of uncertainty for sensitivity analysis. Meta-regression models included adjustment for differences in study and cohort characteristics.
  
  
  RESULTS
  In the base-case scenario, topical fluticasone was about as effective as SFED but more expensive at a 5-year time horizon ($9261.58 vs $5719.72 per person). SFED was more effective and less expensive than topical fluticasone and topical budesonide in the base-case scenario. Probabilistic sensitivity analysis revealed little uncertainty in relative treatment effectiveness. There was somewhat greater uncertainty in the relative cost of treatments; most simulations found SFED to be less expensive.
  
  
  CONCLUSIONS
  In a cost utility analysis comparing topical corticosteroids and SFED for first-line treatment of eosinophilic esophagitis, the therapies were similar in effectiveness. SFED was on average less expensive, and more cost effective in most simulations, than topical budesonide and topical fluticasone, from a payer perspective and not accounting for patient-level costs or quality of life.
authors.affiliation: Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Cary C
authors.initials: CC
authors.lastname: Cotton
authors.affiliation: Department of Health Policy and Management, Gillings School of Public Heath, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Daniel
authors.initials: D
authors.lastname: Erim
authors.affiliation: Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Swathi
authors.initials: S
authors.lastname: Eluri
authors.affiliation: Department of Health Policy and Management, Gillings School of Public Heath, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Sarah H
authors.initials: SH
authors.lastname: Palmer
authors.affiliation: Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Green
authors.affiliation: Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: W Asher
authors.initials: WA
authors.lastname: Wolf
authors.affiliation: Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Runge
authors.affiliation: Department of Health Policy and Management, Gillings School of Public Heath, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Wheeler
authors.affiliation: Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Shaheen
authors.affiliation: Division of Gastroenterology and Hepatology, Center for Esophageal Diseases and Swallowing, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: edellon@med.unc.edu.
authors.forename: Evan S
authors.initials: ES
authors.lastname: Dellon
mesh_terms: D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000191:economics*; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D004032:Diet / Q000191:economics* / Q000379:methods; D057765:Eosinophilic Esophagitis / Q000188:drug therapy* / Q000191:economics*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013256:Steroids / Q000008:administration & dosage / Q000191:economics*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; D013256:Steroids
keywords: Cost Effectiveness; Cost Utility; Diet; Eosinophilic Esophagitis; Steroids; Treatment