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Pioglitazone and vitamin E for non alcoholic steatohepatitis: A cost utility analysis
Hepatology, 06/22/2012
Clinical Article
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%.
