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.

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: Oxford University Press (OUP)
• Peer Reviewed: Peer Reviewed
• Volume: 177
• Issue: 6
• Pages: 1527-1536
• DOI: https://doi.org/10.1111/bjd.15561
• Public URL: https://nottingham-repository.worktribe.com/output/964796
• Publisher URL: http://onlinelibrary.wiley.com/doi/10.1111/bjd.15561/abstract
• Contract Date: May 30, 2017