EoE Module 12 References-Cotton et al Clin Gastroenterol Hepatol 2017 Cost untility analysis of topical steroids compared to dietary elimination for treatment of EoE

Cotton et al Clin Gastroenterol Hepatol 2017 Cost untility analysis of topical steroids compared to dietary elimination for treatment of EoE

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The study compares the cost-utility of topical corticosteroids (tCS) and a six-food elimination diet (SFED) for treating eosinophilic esophagitis (EoE). Utilizing a Markov model, the researchers performed a meta-analysis and cost utility comparison, simulating treatment outcomes over a five-year period from a payer perspective. Their findings indicate that SFED and tCS are similarly effective but SFED is generally less expensive than tCS.<br /><br />In the base case scenario, the SFED was found to cost an average of $5,720 per person over five years, whereas topical fluticasone cost $9,262. While SFED was identified as slightly more effective, it proved to be more cost-effective due to lower costs associated with fewer necessary procedures compared to tCS. Consequently, SFED was considered more cost-effective for EoE treatment.<br /><br />The study incorporated various methods such as systematic reviews and meta-regression to provide baseline estimates of treatment effectiveness. It highlighted that SFED could be a viable first-line treatment option in EoE patients, emphasizing its cost-effective nature without compromising efficacy.<br /><br />Although the study was presented from the payer perspective, acknowledging that SFED can result in additional costs for patients not covered by insurance, the conclusions were limited to insurance-related healthcare costs. Additionally, the study noted substantial uncertainty about some cost factors, and real-world application could vary due to personal circumstances like feasible dietary changes or patient preferences. The study calls for future research into patient-level cost-effectiveness and the impact of these treatments on patients' quality of life. Overall, in the current health system, SFED emerges as a cost-effective primary therapy for managing EoE, although more comprehensive trials comparing SFED and tCS directly are needed.

Keywords

cost-utility

topical corticosteroids

six-food elimination diet

eosinophilic esophagitis

Markov model

cost-effective

treatment outcomes

payer perspective

systematic reviews

quality of life