Pioglitazone and vitamin E for non alcoholic steatohepatitis: A cost utility analysis
Mahady SE et al. – The modelled analyses suggest that in patients with advanced fibrosis due to Non alcoholic steatohepatitis (NASH), pharmacological treatment in addition to standard lifestyle modification is likely to be cost effective.Methods
- Using a third party payer perspective, a deterministic Markov model was developed to compare costs and health benefits of lifestyle modification alone or with pioglitazone or Vitamin E in a cohort of patients aged 50 years with biopsy proven NASH and fibrosis level 3 or greater.
- The authors assumed an annual cycle length over a lifetime horizon.
- Probability and utility estimates were derived from a systematic literature review, and uncertainties in parameter estimates were tested using one and two way sensitivity analyses.
- They outcome measure was the incremental cost effectiveness ratio (ICER), with $A50,000 or less considered cost effective.
- In comparison with lifestyle modification alone, treatment with either pioglitazone or Vitamin E in addition to lifestyle modification was cost effective, with incremental cost effectiveness ratios of $A2058 and $A8083 per quality adjusted life year (QALY) gained, respectively.
- In a direct comparison, pioglitazone was more cost effective than Vitamin E (ICER $A2056/QALY gained).
- Sensitivity analyses indicated that pioglitazone was not cost effective if either the total drug cost was greater than $A16,000 per annum, or the annual probability of developing cirrhosis in advanced fibrosis was less than 2%.