COST-EFFECTIVENESS OF BUDESONIDE ORODISPERSIBLE TABLETS IN TREATMENT OF EOSINOPHILIC ESOPHAGITIS IN THE CZECH REPUBLIC

Objectives
Budesonide is an anti-inflammatory drug (corticosteroid hormone) and in orodispersible formulation is an effective treatment of eosinophilic esophagitis. In the 6week induction treatment 57.6% patients achieved both clinical and histological remission. There is no reimbursed treatment for patients with eosinophilic esophagitis in the Czech Republic. The aim of the analysis was to compare costs and effectiveness of orodispersible formulation budesonide in comparison with placebo in adult patients with eosinophilic esophagitis. 
Methods
To assess on cost-utility of budesonide, a Markov model was developed in Microsoft Excel. Budesonide was compared to placebo over a 5-year time horizon. The effectiveness and quality of life was derived from randomized clinical trials. Since there are no quality of life data for eosinophilic esophagitis, utilities for gastroesophageal reflux disease were used. 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 6 706 EUR/QALY. QALYs gained on budesonide treatment reached 3,8 whereas patients on placebo gained only 3,23 over a 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 90% iterations. 
Conclusion
Based on the results orodispersable formulation of budesonide improves quality of life in eosinophilic esophagitis patients. Moreover, budesonide is also highly cost-effective intervention as the ICER is well below WTP threshold which is 46 725 EUR.