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Ciclosporin compared to prednisolone therapy for patients with pyoderma gangrenosum: cost-effectiveness analysis of the STOP GAP trial

Mason, J.M.; Thomas, K.S.; Ormerod, A.D.; Craig, F.E.; Mitchell, E.; Norrie, J.; Williams, H.C.

Authors

J.M. Mason

A.D. Ormerod

F.E. Craig

ELEANOR MITCHELL eleanor.mitchell@nottingham.ac.uk
Assistant Professor of Clinical Trials

J. Norrie

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



Abstract

Background

Pyoderma gangrenosum (PG) is a painful, ulcerating skin disease with poor evidence for management. Prednisolone and ciclosporin are the most commonly used treatments, although not previously compared within a randomised controlled trial (RCT)
Objectives

To compare the cost-effectiveness of ciclosporin and prednisolone-initiated treatment for patients with PG.
Methods

Quality-of-life (EuroQoL EQ-5D-3L) and resource data were collected as part of the STOP-GAP trial: a multicentre, parallel-group, observer-blind 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 analysis, when compared with prednisolone, ciclosporin was cost-effective due to a reduction in costs (net cost: -£1160; 95%CI: (-2991 to 672) and improvement in quality of life (net QALYs: 0.055; 95%CI: 0.018 to 0.093). However, this finding appears driven by a minority of patients with large lesions (≥20cm2) (net cost: -£5310; 95%CI: -9729 to -891; net QALYs: 0.077; 95%CI: 0.004 to 0.151). The incremental cost-effectiveness of ciclosporin for the majority of patients with smaller lesions was £23,374/QALY although the estimate is imprecise: the probability of being cost-effective at a willingness to pay of £20,000/QALY was 43%.
Conclusions

Consistent with the clinical findings of the STOP-GAP trial, patients with small lesions should receive treatment guided by the side effect profiles of the drugs and patient preference - neither strategy is clearly a preferred use of NHS resources. However, ciclosporin-initiated treatment may be more cost-effective for patients with large lesions.

Citation

Mason, J., Thomas, K., Ormerod, A., Craig, F., Mitchell, E., Norrie, J., & Williams, H. (2017). Ciclosporin compared to prednisolone therapy for patients with pyoderma gangrenosum: cost-effectiveness analysis of the STOP GAP trial. British Journal of Dermatology, 177(6), 1527-1536. https://doi.org/10.1111/bjd.15561

Journal Article Type Article
Acceptance Date Apr 9, 2017
Online Publication Date May 31, 2017
Publication Date Dec 1, 2017
Deposit Date May 30, 2017
Publicly Available Date May 31, 2017
Journal British Journal of Dermatology
Print ISSN 0007-0963
Electronic ISSN 1365-2133
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 177
Issue 6
Pages 1527-1536
DOI https://doi.org/10.1111/bjd.15561
Public URL http://eprints.nottingham.ac.uk/id/eprint/43286
Publisher URL http://onlinelibrary.wiley.com/doi/10.1111/bjd.15561/abstract
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by-nc/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/4.0





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