Colchicine prophylaxis is cost-effective for the prevention of gout flares during the initiation of allopurinol, according to study results published in Arthritis Care & Research.
Investigators developed a simulation model using data from a previously published randomized clinical trial of twice-daily colchicine vs placebo for the prevention of gout flares in patients being initiated with allopurinol. Patient profiles from the original trial were imported to the cost-utility analysis model. The model incurred gout flares at comparable frequencies in the colchicine and placebo arms. The primary outcome was the cost of treatment, expressed as Australian (A) and United States (US) dollars, of gout flares. The cost of gout flare treatment was calculated as a function of medication costs and quality-adjusted life-years (QALYs). Patients in the colchicine arm had the added cost of colchicine, which was estimated using pharmaceutical data from the Australian and US healthcare systems. Reductions in QALYs were calculated using data from prior publications detailing the duration and severity of flare symptoms. A Monte-Carlo simulation was used, and the outcomes from 1000 trials were assessed. The model time frame was 6 months.
The twice-daily colchicine prophylaxis arm incurred a total cost of US$1276 and 0.49 QALYs compared with the placebo arm that had a cost of US$516 and 0.47 QALYs. The incremental cost-effectiveness ratio was an additional US$34,004 per QALY gained, favoring colchicine. Results were more pronounced in Australia, where the cost of colchicine was much lower (costs, A$208 and A$415 in the colchicine and placebo arms, respectively) than in the US. Univariate sensitivity analyses supported the model robustness with changes in input parameters, including colchicine cost. Colchicine emerged as the more cost-effective option, even with input changes in cost of up to 200%. In probabilistic sensitivity analyses, the probability of colchicine prophylaxis being more cost-effective than placebo was 93% in the US and 100% in the Australian setting.
These data support colchicine prophylaxis as a cost-effective option for preventing gout flares in both Australian and US healthcare settings.
Results may not be generalizable to patients initiating other urate lowering therapies or to individuals in other countries with different healthcare settings.
These results “[suggest] that not only is colchicine clinically effective in reducing gout flare whilst commencing allopurinol but also cost effective,” the investigators wrote.
Disclosure: Study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.
Robinson PC, Dalbeth N, Donovan P. Colchicine prophylaxis of gout flares when commencing allopurinol is very cost effective [published online June 17, 2020]. Arthritis Care Res. doi:10.1002/acr.24357