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Pioglitazone and vitamin E for nonalcoholic steatohepatitis: A cost utility analysis
Author(s) -
Mahady Suzanne E.,
Wong Germaine,
Craig Jonathan C.,
George Jacob
Publication year - 2012
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1002/hep.25887
Subject(s) - pioglitazone , medicine , quality adjusted life year , nonalcoholic steatohepatitis , cost effectiveness , incremental cost effectiveness ratio , nonalcoholic fatty liver disease , cost–utility analysis , cirrhosis , diabetes mellitus , type 2 diabetes , fatty liver , disease , endocrinology , risk analysis (engineering)
Nonalcoholic steatohepatitis (NASH) is the commonest liver disease in developed countries. However, there are no current data on the cost‐effectiveness of therapeutic options such as lifestyle modification, pioglitazone, or vitamin E. We undertook a cost utility analysis to compare these strategies. Using a third‐party payer perspective, a deterministic Markov model was developed to compare costs and health benefits of lifestyle modification alone or with pioglitazone or vitamin E in a cohort of patients aged 50 years with biopsy‐proven NASH and fibrosis level 3 or greater. We assumed an annual cycle length over a lifetime horizon. Probability and utility estimates were derived from a systematic literature review, and uncertainties in parameter estimates were tested using one‐ and two‐way sensitivity analyses. Our outcome measure was the incremental cost‐effectiveness ratio (ICER), with $A50,000 or less considered cost‐effective. In comparison with lifestyle modification alone, treatment with either pioglitazone or vitamin E in addition to lifestyle modification was cost‐effective, with incremental cost‐effectiveness ratios of $A2748 and $A8475 per quality‐adjusted life year (QALY) gained, respectively. In a direct comparison, pioglitazone was more cost‐effective than vitamin E (ICER $A2,056/QALY gained). Sensitivity analyses indicated that pioglitazone was not cost‐effective if either the total drug cost was greater than $A16,000 per annum, or the annual probability of developing cirrhosis in advanced fibrosis was less than 2%. Conclusion : Our modeled analyses suggest that in patients with advanced fibrosis due to NASH, pharmacological treatment in addition to standard lifestyle modification is likely to be cost‐effective. (H EPATOLOGY 2012;56:2172–2179)