Payer decision-making with limited comparative and cost effectiveness data: the case of new pharmacological treatments for gout

Evidence-based Medicine
Michele MeltzerEric Jutkowitz

Abstract

The need for comparative effectiveness (CE) data continues to grow, fuelled by market demand as well as health reform. There may be an assumption that new drugs result in improved efficacy compared with the standard of care, therefore warranting premium prices. Gout treatment has recently become controversial, as expensive new drugs enter the market with limited CE data. The authors reviewed published clinical trials and conducted a cost effectiveness analysis on a new drug (febuxostat) versus the standard (allopurinol) to illustrate the limitations in using these data to inform evidence-based decision-making. Although febuxostat trials included allopurinol as a comparator, methodological limitations make comparative effectiveness evaluations difficult. However, when available trial data were input to a decision analytic model, the authors found that a significant reduction in febuxostat cost would be required in order for it to dominate allopurinol in cost effectiveness analysis. This case exemplifies the challenges of using clinical trial data in comparative and cost effectiveness analyses.

Citations

Nov 5, 2015·Journal of Medical Economics·Lee J SmolenAki Shiozawa
Feb 9, 2016·Journal of Medical Economics·F Perez-RuizD Carcedo
Jul 28, 2016·Annals of the Rheumatic Diseases·P RichetteT Bardin
Oct 3, 2017·Rheumatology·Kristen Davies, Marwan A S Bukhari
Aug 10, 2021·International Journal of Inflammation·Irandi Putra PratomoAryo Tedjo

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