A cost-effectiveness analysis of MMX mesalazine compared with mesalazine in the treatment of mild-to-moderate ulcerative colitis from a UK perspective

Abstract

Objectives: To perform a cost-utility analysis of a new formulation of mesalazine (Mezavant XL, MMX mesalazine) versus an existing oral mesalazine (Asacol; mesalazine) from the UK National Health Service perspective.

Methods: A 5-year Markov cohort model was developed. Costs were obtained from the literature and utilities from an independent study. Uncertainty was evaluated using one-way and probabilistic sensitivity analyses (PSA). The potential effect of dosing frequency on adherence and possible long-term effects of remission maintenance on colorectal cancer (CRC) rates were also investigated.

Results: The model suggested that 5-year therapy with MMX mesalazine was likely to generate gains when compared with mesalazine, including a gain of 0.011 QALYs per patient, 19 more remission days, and 12% fewer hospitalizations and surgical episodes. These gains came at an increase in total NHS direct cost of £8, resulting in an incremental cost-effectiveness ratio (ICER) of £749. The PSA suggested that MMX mesalazine had a 62% chance of resulting in cost savings, and a 74% chance of being cost effective (£20,000 threshold). Extended analysis including adherence and CRC effects suggested further incremental benefit of MMX mesalazine over mesalazine could be expected. Limitations include uncertainty in extrapolation to a 5-year time horizon and impact of adherence and drug acquisition costs on outcomes.

Conclusion: The pharmacoeconomic analysis suggested that MMX mesalazine is likely to produce small, but worthwhile, increases in total NHS direct cost while increasing time in remission and associated quality of life, when compared with mesalazine. Advantages in adherence to treatment with MMX mesalazine relative to mesalazine suggested that further health gains and cost savings can be obtained. Overall, these results suggest that MMX mesalazine is a cost-effective treatment for UC.

Key words::

• cost effectiveness
• mesalazine
• ulcerative colitis

Transparency

Declaration of funding: This study was funded by Shire Pharmaceuticals.

Declaration of financial/other relationships:NB and RA have disclosed that they received funding from Shire Pharmaceuticals to conduct this study. KB and MAK have disclosed that they have received funding from Shire and have participated in advisory panels sponsored by Shire Pharmaceuticals. SY has disclosed that he was an employee of Shire Pharmaceuticals during the time this study was conducted, and PH has disclosed that he is a current employee of Shire Pharmaceuticals and holds stock in the company.

The JME peer reviewers 1 and 2 have not received an honorarium for their review work on this manuscript. Both have disclosed that they have no relevant financial relationships.

AcknowledgementsThe authors would like to acknowledge the editorial assistance of Aruna Seth, PhD, of PAREXEL, USA in revising this manuscript per peer-review comments. Funding for this assistance was provided by Shire Pharmaceuticals.

Notes

* Mezalant XL is a registered trademark of Shire Pharmaceuticals Inc., Wayne, PA, USA.

* Asacol is a registered trademark of Procter & Gamble Pharmaceuticals, Cincinnati, OH, USA.