Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis

• Published in: Clinical gastroenterology and hepatology Vol. 15; no. 6; pp. 841 - 849.e1
• Main Authors: Cotton, Cary C, Erim, Daniel, Eluri, Swathi, Palmer, Sarah H, Green, Daniel J, Wolf, W. Asher, Runge, Thomas M, Wheeler, Stephanie, Shaheen, Nicholas J, Dellon, Evan S
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2017
• Subjects: Administration, Topical; Adult; Aged; Anti-Inflammatory Agents - administration & dosage; Anti-Inflammatory Agents - economics; Cohort Studies; Cost Effectiveness; Cost Utility; Cost-Benefit Analysis; Diet; Diet - economics; Diet - methods; Eosinophilic Esophagitis; Eosinophilic Esophagitis - drug therapy; Eosinophilic Esophagitis - economics; Female; Gastroenterology and Hepatology; Humans; Male; Middle Aged; Steroids; Steroids - administration & dosage; Steroids - economics; Treatment; Young Adult; quality-adjusted life-year; 6-food elimination diet; topical corticosteroids; tCS; PPI; proton pump inhibitor; probabilistic sensitivity analysis; Cost Utility; Treatment; Cost Effectiveness; Diet; SFED; QALY; EoE; high-power field; Eosinophilic Esophagitis; Steroids; hpf; PSA
• ISSN: 1542-3565; 1542-7714
• DOI: 10.1016/j.cgh.2016.11.032

Background & Aims Topical corticosteroids or dietary elimination are recommended as first-line therapies for eosinophilic esophagitis, but data to directly compare these therapies are scant. We performed a cost utility comparison of topical corticosteroids and the 6-food elimination diet (SFED) in treatment of eosinophilic esophagitis, from the payer perspective. Methods We used a modified Markov model based on current clinical guidelines, in which transition between states depended on histologic response simulated at the individual cohort-member level. Simulation parameters were defined by systematic review and meta-analysis to determine the base-case estimates and bounds of uncertainty for sensitivity analysis. Meta-regression models included adjustment for differences in study and cohort characteristics. Results In the base-case scenario, topical fluticasone was about as effective as SFED but more expensive at a 5-year time horizon ($9261.58 vs $5719.72 per person). SFED was more effective and less expensive than topical fluticasone and topical budesonide in the base-case scenario. Probabilistic sensitivity analysis revealed little uncertainty in relative treatment effectiveness. There was somewhat greater uncertainty in the relative cost of treatments; most simulations found SFED to be less expensive. Conclusions In a cost utility analysis comparing topical corticosteroids and SFED for first-line treatment of eosinophilic esophagitis, the therapies were similar in effectiveness. SFED was on average less expensive, and more cost effective in most simulations, than topical budesonide and topical fluticasone, from a payer perspective and not accounting for patient-level costs or quality of life.