Doxycycline compared with prednisolone therapy for patients with bullous pemphigoid: cost‐effectiveness analysis of the BLISTER trial. (1st February 2018)

• Record Type: Journal Article
• Authors: Mason, J.M.; Chalmers, J.R.; Godec, T.; Nunn, A.J.; Kirtschig, G.; Wojnarowska, F.; Childs, M.; Whitham, D.; Schmidt, E.; Harman, K.; Walton, S.; Chapman, A.; Williams, H.C.
• Is Part Of: British journal of dermatology. Volume 178:Number 2(2018)
• Page Start: 415
• Page End: 423
• Publication Date: 2018-02-01
• Subjects: Dermatology -- Periodicals; Skin -- Diseases -- Periodicals; 616.5
• DOI: 10.1111/bjd.16006
• Languages: English
• ISSNs: 0007-0963

Abstract

Summary: Background : Bullous pemphigoid (BP) is an autoimmune blistering skin disorder associated with significant morbidity and mortality. Doxycycline and prednisolone to treat bullous pemphigoid were compared within a randomized controlled trial (RCT). Objectives : To compare the cost‐effectiveness of doxycycline‐initiated and prednisolone‐initiated treatment for patients with BP. Methods : Quality‐of‐life (EuroQoL‐5D‐3L) and resource data were collected as part of the BLISTER trial: a multicentre, parallel‐group, investigator‐blinded RCT. Within‐trial analysis was performed using bivariate regression of costs and quality‐adjusted life‐years (QALYs), with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost‐effectiveness from a health service perspective. Results : In the base case, there was no robust difference in costs or QALYs per patient at 1 year comparing doxycycline‐ with prednisolone‐initiated therapy [net cost £959, 95% confidence interval (CI) −£24 to £1941; net QALYs −0·024, 95% CI −0·088 to 0·041]. However, the findings varied by baseline blister severity. For patients with mild or moderate blistering (≤ 30 blisters) net costs and outcomes were similar. For patients with severe blistering (> 30 blisters) net costs were higher (£2558, 95% CI −£82 to £5198) and quality of life poorer (−0·090 QALYs, 95% CI −0·22 to 0·042) for patients starting on doxycycline. The probability that doxycycline would be cost‐effective for those with severe pemphigoid was 1·5% at a willingness to pay of £20 000 per QALY. Conclusions : Consistently with the clinical findings of the BLISTER trial, patients with mild or moderate blistering should receive treatment guided by the safety and effectiveness of the drugs and patient preference – neither strategy is clearly a preferred use of National Health Service resources. However, prednisolone‐initiated treatment may be more cost‐effective for patients with severe blistering.