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

Cary C. Cotton, Daniel Erim, Swathi Eluri, Sarah H. Palmer, Daniel J. Green, W. Asher Wolf, Thomas M. Runge, Stephanie Wheeler, Nicholas J. Shaheen, Evan S. Dellon

Research output: Contribution to journalArticle

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Abstract

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.

LanguageEnglish (US)
Pages841-849.e1
JournalClinical Gastroenterology and Hepatology
Volume15
Issue number6
DOIs
StatePublished - Jun 1 2017

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Eosinophilic Esophagitis
Cost-Benefit Analysis
Steroids
Uncertainty
Budesonide
Adrenal Cortex Hormones
Costs and Cost Analysis
Therapeutics
Health Care Costs
Meta-Analysis
Cohort Studies
Quality of Life
Guidelines
Diet
Food
Fluticasone

Keywords

  • Cost Effectiveness
  • Cost Utility
  • Diet
  • Eosinophilic Esophagitis
  • Steroids
  • Treatment

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

Cite this

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

In: Clinical Gastroenterology and Hepatology, Vol. 15, No. 6, 01.06.2017, p. 841-849.e1.

Research output: Contribution to journalArticle

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./ Cost Utility Analysis of Topical Steroids Compared With Dietary Elimination for Treatment of Eosinophilic Esophagitis. In: Clinical Gastroenterology and Hepatology. 2017 ; Vol. 15, No. 6. pp. 841-849.e1
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AU - Erim,Daniel

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AU - Green,Daniel J.

AU - Wolf,W. Asher

AU - Runge,Thomas M.

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N2 - 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.

AB - 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.

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