COST-EFFECTIVENESS OF BUDESONIDE IN MICROSCOPIC COLITIS PATIENTS IN THE CZECH REPUBLIC

Objectives
Budesonide is an anti-inflammatory drug (corticosteroid hormone) and is an effective treatment of microscopic colitis. It increases probability of achieving short-term clinical remission as well as maintaining long-term remission, according to recent clinical evidence. There is no reimbursed treatment for patients in the Czech Republic. The aim of the analysis was to compare costs and effectiveness of budesonide in comparison with placebo in adult patients with microscopic colitis. 

Methods
To assess on cost-utility of budesonide, a Markov model was developed in Microsoft Excel. Budesonide was compared to placebo over a 1.5-year time horizon. The effectiveness and quality of life was derived from randomized clinical trials. Short-form 6D utilities were mapped from Gastrointestinal Quality of Life Index (GIQLI) according to Lee et al. (2013) findings. Cost analysis reflected current situation in the Czech Republic. Drug costs, adverse event costs, and management costs were included. The analysis was conducted from the perspective of the public healthcare payer.

Results
In the base case scenario, the incremental cost-effectiveness ratio (ICER) of budesonide compared to placebo reached 7 591 EUR/QALY. QALYs gained on budesonide treatment reached 0.98 whereas patients on placebo gained only 0,92 over a 1.5-year time horizon. Sensitivity and scenario analyses verified model robustness and stability of results. Probabilistic sensitivity analysis resulted in ICER below willingness to pay (WTP) threshold in 88% iterations. 

Conclusion
Based on the results budesonide improves quality of life of microscopic colitis patients. Moreover, budesonide is also highly cost-effective intervention as the ICER is well below WTP threshold which is 47 244 EUR.