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Cost and health consequences of treatment of primary biliary cirrhosis with ursodeoxycholic acid
Author(s) -
Boberg K. M.,
Wisløff T.,
Kjøllesdal K. S.,
Støvring H.,
Kristiansen I. S.
Publication year - 2013
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/apt.12435
Subject(s) - ursodeoxycholic acid , medicine , primary biliary cirrhosis , life expectancy , liver transplantation , cohort , gastroenterology , hazard ratio , transplantation , population , confidence interval , environmental health
Summary Background Long‐term use of ursodeoxycholic acid ( UDCA ) is the recommended therapy in primary biliary cirrhosis ( PBC ). The lifetime effectiveness and cost‐effectiveness of UDCA in PBC have, however, not been assessed. Aim To estimate the health outcomes and lifetime costs of a Norwegian cohort of PBC patients on UDCA . Methods Norwegian PBC patients ( n = 182) (90% females; mean age 56.3 ± 8.9 years; Mayo risk score 4.38) who were included in a 5‐year open‐label study of UDCA therapy were subsequently followed up for up to 11.5 years. The lifetime survival was estimated using a Weibull survival model. The survival benefit from UDCA was based on a randomised clinical trial from Canada, comparing the effect of non‐ UDCA and UDCA . Survival and costs of standard care vs. standard care plus UDCA were simulated in a Markov model with death and liver transplantation as major events, invoking transition of a patient's state in the model. Results The gain in life expectancy for a PBC patient on UDCA compared with standard care was 2.24 years (1.19 years discounted). The lifetime treatment costs were EUR 151 403 and EUR 157 741 ( EUR 102 912 and EUR 115 031 discounted) for patients with and without UDCA respectively. A probabilistic sensitivity analysis indicated an 82% probability that UDCA entails both greater life expectancy and lower costs than standard care. Conclusions The results of this study indicate that UDCA therapy is a dominant strategy as it confers reduced morbidity and mortality, as well as cost savings, compared with standard therapy.