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Doxycycline compared to prednisolone therapy for patients with bullous pemphigoid: cost-effectiveness analysis of the BLISTER trial

Mason, James M.; Chalmers, J.R.; Godec, Thomas R.; Nunn, Andrew J.; Kirtschig, Gudula; Wojnarowska, Fenella; Childs, Margaret; Whitham, Diane; Schmidt, Enno; Harman, Karen; Walton, Shernaz; Chapman, Anna; Williams, Hywel C.

Authors

James M. Mason

J.R. Chalmers

Thomas R. Godec

Andrew J. Nunn

Gudula Kirtschig

Fenella Wojnarowska

Margaret Childs

Diane Whitham

Enno Schmidt

Karen Harman

Shernaz Walton

Anna Chapman

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HYWEL WILLIAMS hywel.williams@nottingham.ac.uk
Professor of Dermato-Epidemiology



Abstract

Background: Bullous pemphigoid (BP) is an autoimmune blistering skin disorder associated with significant morbidity and mortality. Doxycycline and prednisolone to treat bullous pemphigoid were compared within a randomised controlled trial (RCT).

Objectives: To compare the cost-effectiveness of doxycycline-initiated and prednisolone-initiated treatment for patients with BP.

Methods: Quality-of-life (EuroQoL EQ-5D-3L) and resource data were collected as part of the BLISTER trial: a multicentre, parallel-group, investigator-blinded RCT. Within-trial analysis used bivariate regression of costs and QALYs, with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective.

Results: In the base case, there was no robust difference in costs or QALYs per patient at 1 year comparing doxycycline-initiated therapy with prednisolone-initiated therapy (net cost: £959, 95% CI –£24 to £1941; net QALYs: –0.024, 95% CI –0.088 to 0.041). However, findings varied by baseline blister severity. For patients with mild or moderate blistering (≤30) net costs and outcomes were similar. For patients with severe blistering (>30) net costs were higher (£2558, 95% CI –£82 to £5198) and quality of life poorer (–0.090 QALYs, 95% CI–0.222 to 0.042) for patients starting on doxycycline. The probability that doxycycline would be cost-effective for those with severe pemphigoid was 1.5% at a willingness to pay of £20,000/QALY.

Conclusions: Consistent with the clinical findings of the BLISTER trial, patients with mild or moderate blistering should receive treatment guided by the safety and effectiveness of the drugs and patient preference - neither strategy is clearly a preferred use of NHS resources. However, prednisolone-initiated treatment may be more cost-effective for patients with severe blistering.

Citation

Mason, J. M., Chalmers, J., Godec, T. R., Nunn, A. J., Kirtschig, G., Wojnarowska, F., …Williams, H. C. (in press). Doxycycline compared to prednisolone therapy for patients with bullous pemphigoid: cost-effectiveness analysis of the BLISTER trial. British Journal of Dermatology, 178, https://doi.org/10.1111/bjd.16006

Journal Article Type Article
Acceptance Date Sep 12, 2017
Online Publication Date Jan 15, 2018
Deposit Date Sep 29, 2017
Publicly Available Date Jan 15, 2018
Journal British Journal of Dermatology
Print ISSN 0007-0963
Electronic ISSN 1365-2133
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 178
DOI https://doi.org/10.1111/bjd.16006
Public URL http://eprints.nottingham.ac.uk/id/eprint/46817
Publisher URL https://onlinelibrary.wiley.com/doi/abs/10.1111/bjd.16006
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc-nd/4.0





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