Eric Jutkowitz, BA; Hyon K. Choi, MD, DrPH; Laura T. Pizzi, PharmD, MPH; Karen M. Kuntz, ScD
Grant Support: This work was funded through Mr. Jutkowitz's doctoral training at the University of Minnesota. Mr. Jutkowitz is supported by a grant from the Agency for Healthcare Research and Quality National Research Service Award Traineeship (T32) and the Hearst Fellowship in Public Health and Aging. Dr. Choi is supported by National Institutes of Health (National Institute of Arthritis and Musculoskeletal and Skin Diseases) grants R01-AR056291, R01-AR065944, P60 AR047785, and R21 AR056042.
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-0227.
Reproducible Research Statement:Study protocol: Not applicable. Statistical code: Available from Mr. Jutkowitz (e-mail, Jutko001@umn.edu). Data set: Input parameters and sources are provided in the text.
Requests for Single Reprints: Eric Jutkowitz, BA, Division of Health Policy and Management, School of Public Health, University of Minnesota, MMC 729, 420 Delaware Street SE, Minneapolis, MN 55455; e-mail, Jutko001@umn.edu.
Current Author Addresses: Mr. Jutkowitz and Dr. Kuntz: Division of Health Policy and Management, School of Public Health, University of Minnesota, MMC 729, 420 Delaware Street SE, Minneapolis, MN 55455.
Dr. Choi: Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Bulfinch 165, Boston, MA 02114.
Dr. Pizzi: Thomas Jefferson University, Jefferson School of Pharmacy, 901 Walnut Street, Health Professions Academic Building, Philadelphia, PA 19017.
Author Contributions: Conception and design: E. Jutkowitz, H.K. Choi, L.T. Pizzi.
Analysis and interpretation of the data: E. Jutkowitz, H.K. Choi, L.T. Pizzi, K.M. Kuntz.
Drafting of the article: E. Jutkowitz, H.K. Choi.
Critical revision of the article for important intellectual content: E. Jutkowitz, H.K. Choi, L.T. Pizzi, K.M. Kuntz.
Final approval of the article: E. Jutkowitz, H.K. Choi, L.T. Pizzi, K.M. Kuntz.
Provision of study materials or patients: E. Jutkowitz.
Statistical expertise: E. Jutkowitz, H.K. Choi, K.M. Kuntz.
Obtaining of funding: E. Jutkowitz.
Administrative, technical, or logistic support: E. Jutkowitz, H.K. Choi, K.M. Kuntz.
Collection and assembly of data: E. Jutkowitz, H.K. Choi.
Gout is the most common inflammatory arthritis in the United States.
To evaluate the cost-effectiveness of urate-lowering treatment strategies for the management of gout.
Published literature and expert opinion.
Patients for whom allopurinol or febuxostat is a suitable initial urate-lowering treatment.
Health care payer.
5 urate-lowering treatment strategies were evaluated: no treatment; allopurinol- or febuxostat-only therapy; allopurinol–febuxostat sequential therapy; and febuxostat–allopurinol sequential therapy. Two dosing scenarios were investigated: fixed dose (80 mg of febuxostat daily, 0.80 success rate; 300 mg of allopurinol daily, 0.39 success rate) and dose escalation (≤120 mg of febuxostat daily, 0.82 success rate; ≤800 mg of allopurinol daily, 0.78 success rate).
Discounted costs, discounted quality-adjusted life-years, and incremental cost-effectiveness ratios.
In both dosing scenarios, allopurinol-only therapy was cost-saving. Dose-escalation allopurinol–febuxostat sequential therapy was more costly but more effective than dose-escalation allopurinol therapy, with an incremental cost-effectiveness ratio of $39 400 per quality-adjusted life-year.
The relative rankings of treatments did not change. Our results were relatively sensitive to several potential variations of model assumptions; however, the cost-effectiveness ratios of dose escalation with allopurinol–febuxostat sequential therapy remained lower than the willingness-to-pay threshold of $109 000 per quality-adjusted life-year.
Long-term outcome data for patients with gout, including medication adherence, are limited.
Allopurinol single therapy is cost-saving compared with no treatment. Dose-escalation allopurinol–febuxostat sequential therapy is cost-effective compared with accepted willingness-to-pay thresholds.
Agency for Healthcare Research and Quality.
Jutkowitz E, Choi HK, Pizzi LT, Kuntz KM. Cost-Effectiveness of Allopurinol and Febuxostat for the Management of Gout. Ann Intern Med. ;161:617–626. doi: 10.7326/M14-0227
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Published: Ann Intern Med. 2014;161(9):617-626.
Gout, Healthcare Delivery and Policy, High Value Care, Rheumatology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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