Author/Authors :
Rezapour, Aziz Health Management and Economics Research Center - Iran University of Medical Sciences, Tehran, Iran , Alidoost, Saeide Health Management and Economics Research Center - Iran University of Medical Sciences, Tehran, Iran , Asgharzadeh, Asra Health Technology Assessment Group - Universal Scientific Education and Research Network, Tehran, Iran , Farhadi, Zeynab Health Management and Economics Research Center - Iran University of Medical Sciences, Tehran, Iran , Khodadadi, Najme Health Management and Economics Research Center - Iran University of Medical Sciences, Tehran, Iran , Mohammadi Bakhsh, Roghayeh Health Management and Economics Research Center - Iran University of Medical Sciences, Tehran, Iran , Sepehrian, Razieh Health Management and Economics Research Center - Iran University of Medical Sciences, Tehran, Iran , Salemi, Morteza Health Management and Economics Research Center - Iran University of Medical Sciences, Tehran, Iran , Taheri Mirghaed, Masood Health Management and Economics Research Center - Iran University of Medical Sciences, Tehran, Iran , Behzadifar, Masoud Health Management and Economics Research Center - Iran University of Medical Sciences, Tehran, Iran , Sohrabi, Rahim Health Management and Economics Research Center - Iran University of Medical Sciences, Tehran, Iran
Abstract :
Background: In recent years, increased longevity, poor dietary habits, and the rising prevalence of metabolic syndrome and
hypertension have increased the prevalence of gout. Gout significantly increases direct and indirect costs and reduces the quality of
life. Allopurinol and febuxostat are the most commonly used drugs for reducing uric acid levels and controlling this disease with
different cost-effectiveness. The present systematic review compares the cost-effectiveness of these drugs.
Methods: This was a systematic review of economic evaluations. Cochrane CENTRAL, Web of Science, PubMed, Embase, and the
Cost-Effectiveness Analysis (CEA) Registry were searched up to April 30, 2018, based on the specific search strategy of each
database. Keywords used in the search include gout, cost-effectiveness, allopurinol, and febuxostat in MeSH and free-text forms.
Screening of identified studies, data extraction, and quality assessment were done independently by 2 reviewers. The quality of studies
was assessed based on Drummond Checklist. Finally, a qualitative analysis was done to analyze the results.
Results: A total of 94 studies were identified through database search and the review of references. After screening the titles,
abstracts, and full-texts, 6 economic evaluations were included in the review. The majority of the studies had been conducted in the US
using the Markov model, within a 5-year horizon, and from the payer’s perspective, with the quality of life as a measure of
effectiveness. In most studies, the incremental cost-effectiveness ratios (ICERs) of febuxostat per quality-adjusted life year (QALY)
were below the threshold (10 000$/QALY and 30 000€/QALY).
Conclusion: Febuxostat has been shown to be more cost-effective than allopurinol in all treatment sequences in studies that have
used uric acid levels as the measure of effectiveness. Furthermore, in studies with the quality of life as the measure of effectiveness,
febuxostat has been shown to be very cost-effective as the second-line treatment.
Keywords :
Gout , Economic evaluation , Cost-Effectiveness , Allopurinol , Febuxostat , Systematic review
