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The Cost Effectiveness of Lubiprostone in Chronic Idiopathic Constipation

Pennington, B; Marriott, E-R; Lichtlen, P; Akbar, A; Hatswell, AJ; (2018) The Cost Effectiveness of Lubiprostone in Chronic Idiopathic Constipation. PharmacoEconomics - Open , 2 (3) pp. 241-253. 10.1007/s41669-017-0065-9. Green open access

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Abstract

OBJECTIVE: The objective of this study was to evaluate the cost effectiveness of lubiprostone, prucalopride, placebo and immediate referral to secondary care in chronic idiopathic constipation (CIC) in an economic model that was used by the UK National Institute for Health and Care Excellence (NICE) in developing guidance. METHODS: We developed a cohort state-transition model to reflect the treatment pathway in CIC from the UK NHS and personal social services perspective. Time on treatment was determined by a treatment continuation rule using data from an indirect comparison and survival curves fitted to long-term data. Quality of life was defined by whether CIC was resolved or unresolved, using published values. Costs were determined by drug acquisition costs, invasive procedures and healthcare resource use (associated with resolved or unresolved CIC), using published UK sources. Deterministic and probabilistic sensitivity analyses were conducted. RESULTS: Over a 10-year time horizon, lubiprostone was more costly and more effective than placebo and immediate referral to secondary care, with incremental cost-effectiveness ratios (ICERs) of £58,979 and £21,152. Lubiprostone dominated prucalopride in the base case and with a time horizon of 1 year. The main sensitivity for the comparison against placebo was the assumptions around placebo cost and efficacy. The main sensitivity for the comparison against prucalopride was the endpoint used in the indirect comparison. CONCLUSION: Lubiprostone may be cost effective compared with prucalopride or immediate referral but not compared with placebo in the base case. The implementation of the guidance issued by NICE should increase quality of life for patients with CIC and provide a further treatment option.

Type: Article
Title: The Cost Effectiveness of Lubiprostone in Chronic Idiopathic Constipation
Open access status: An open access version is available from UCL Discovery
DOI: 10.1007/s41669-017-0065-9
Publisher version: https://doi.org/10.1007/s41669-017-0065-9
Language: English
Additional information: © The Author(s) 2018. This article is open access and distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/ licenses/by-nc/4.0/), which permits any noncommercial use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > UCL BEAMS
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences
UCL > Provost and Vice Provost Offices > UCL BEAMS > Faculty of Maths and Physical Sciences > Dept of Statistical Science
URI: http://discovery.ucl.ac.uk/id/eprint/10067297
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