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Article: Treatment for severe lupus nephritis: A cost-effectiveness analysis in China
Title | Treatment for severe lupus nephritis: A cost-effectiveness analysis in China |
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Authors | |
Keywords | Cost-Effectiveness severe lupus nephritis Markov model therapeutic strategies clinical prognosis |
Issue Date | 2021 |
Publisher | Frontiers Research Foundation. The Journal's web site is located at http://www.frontiersin.org/pharmacology |
Citation | Frontiers in Pharmacology, 2021, v. 12, p. article no. 678301 How to Cite? |
Abstract | Background: Lupus nephritis (LN) is the most common secondary glomerular diseases that will cause end-stage renal disease (ESRD) and renal-related death. The cost-effectiveness of various treatments for LN recommended by official guidelines has not been investigated in China. Our study is to evaluate clinical prognosis and cost-effectiveness of the current treatments for severe LN.
Methods: A Markov model was simulated for 1,000 LN patients of 30 years old, over a 3-years and 30-years lifetime horizon respectively. We assessed the cost-effectiveness of six therapeutic strategies from a societal perspective, with cyclophosphamide (CYC) or mycophenolate mofetil (MMF) induction therapy followed by CYC, MMF or azathioprine (AZA) maintenance therapy. Main outcomes included quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER) and clinical prognosis. One and three times gross domestic product (GDP) per capita were used as the willingness-to-pay (WTP) thresholds. We also carried out sensitivity analysis under a lifetime horizon.
Results: Compared with the baseline strategy of CYC induction and maintenance, for a 3-years horizon the most cost-effective strategy was CYC induction and AZA maintenance with $448 per QALY gained, followed by MMF induction and AZA maintenance which however was not cost-effective under the one times GDP per capita WTP threshold. For a lifetime horizon, CYC induction and AZA maintenance remained the most cost-effective strategy but MMF induction and maintenance became cost-effective under the one times GDP per capita WTP threshold and achieved a higher complete remission rate (57.2 versus 48.9%) and lower risks of ESRD (3.3 versus 5.8%) and all-cause mortality (36.0 versus 40.8%). The risk of developing ESRD during maintenance was the most influential parameter affecting ICER.
Conclusions: The strategy of CYC induction followed by AZA maintenance was the most cost-effective strategy in China for short-term treatment, while the strategy of MMF in both induction and maintenance became cost-effective and yielded more desirable clinical outcomes for lifetime treatment. The uncertainty analysis supported the need for monitoring the progression to ESRD. |
Persistent Identifier | http://hdl.handle.net/10722/306426 |
ISSN | 2023 Impact Factor: 4.4 2023 SCImago Journal Rankings: 1.066 |
PubMed Central ID | |
ISI Accession Number ID |
DC Field | Value | Language |
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dc.contributor.author | DAI, Z | - |
dc.contributor.author | Zhang, X | - |
dc.contributor.author | Wong, IOL | - |
dc.contributor.author | Lau, EHY | - |
dc.contributor.author | Lin, Z | - |
dc.date.accessioned | 2021-10-22T07:34:26Z | - |
dc.date.available | 2021-10-22T07:34:26Z | - |
dc.date.issued | 2021 | - |
dc.identifier.citation | Frontiers in Pharmacology, 2021, v. 12, p. article no. 678301 | - |
dc.identifier.issn | 1663-9812 | - |
dc.identifier.uri | http://hdl.handle.net/10722/306426 | - |
dc.description.abstract | Background: Lupus nephritis (LN) is the most common secondary glomerular diseases that will cause end-stage renal disease (ESRD) and renal-related death. The cost-effectiveness of various treatments for LN recommended by official guidelines has not been investigated in China. Our study is to evaluate clinical prognosis and cost-effectiveness of the current treatments for severe LN. Methods: A Markov model was simulated for 1,000 LN patients of 30 years old, over a 3-years and 30-years lifetime horizon respectively. We assessed the cost-effectiveness of six therapeutic strategies from a societal perspective, with cyclophosphamide (CYC) or mycophenolate mofetil (MMF) induction therapy followed by CYC, MMF or azathioprine (AZA) maintenance therapy. Main outcomes included quality-adjusted life years (QALYs), incremental cost-effectiveness ratio (ICER) and clinical prognosis. One and three times gross domestic product (GDP) per capita were used as the willingness-to-pay (WTP) thresholds. We also carried out sensitivity analysis under a lifetime horizon. Results: Compared with the baseline strategy of CYC induction and maintenance, for a 3-years horizon the most cost-effective strategy was CYC induction and AZA maintenance with $448 per QALY gained, followed by MMF induction and AZA maintenance which however was not cost-effective under the one times GDP per capita WTP threshold. For a lifetime horizon, CYC induction and AZA maintenance remained the most cost-effective strategy but MMF induction and maintenance became cost-effective under the one times GDP per capita WTP threshold and achieved a higher complete remission rate (57.2 versus 48.9%) and lower risks of ESRD (3.3 versus 5.8%) and all-cause mortality (36.0 versus 40.8%). The risk of developing ESRD during maintenance was the most influential parameter affecting ICER. Conclusions: The strategy of CYC induction followed by AZA maintenance was the most cost-effective strategy in China for short-term treatment, while the strategy of MMF in both induction and maintenance became cost-effective and yielded more desirable clinical outcomes for lifetime treatment. The uncertainty analysis supported the need for monitoring the progression to ESRD. | - |
dc.language | eng | - |
dc.publisher | Frontiers Research Foundation. The Journal's web site is located at http://www.frontiersin.org/pharmacology | - |
dc.relation.ispartof | Frontiers in Pharmacology | - |
dc.rights | This Document is Protected by copyright and was first published by Frontiers. All rights reserved. It is reproduced with permission. | - |
dc.rights | This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. | - |
dc.subject | Cost-Effectiveness | - |
dc.subject | severe lupus nephritis | - |
dc.subject | Markov model | - |
dc.subject | therapeutic strategies | - |
dc.subject | clinical prognosis | - |
dc.title | Treatment for severe lupus nephritis: A cost-effectiveness analysis in China | - |
dc.type | Article | - |
dc.identifier.email | Wong, IOL: iolwong@hku.hk | - |
dc.identifier.email | Lau, EHY: ehylau@hku.hk | - |
dc.identifier.authority | Wong, IOL=rp01806 | - |
dc.identifier.authority | Lau, EHY=rp01349 | - |
dc.description.nature | published_or_final_version | - |
dc.identifier.doi | 10.3389/fphar.2021.678301 | - |
dc.identifier.pmid | 34552479 | - |
dc.identifier.pmcid | PMC8450585 | - |
dc.identifier.scopus | eid_2-s2.0-85115239217 | - |
dc.identifier.hkuros | 328937 | - |
dc.identifier.volume | 12 | - |
dc.identifier.spage | article no. 678301 | - |
dc.identifier.epage | article no. 678301 | - |
dc.identifier.isi | WOS:000698631600001 | - |
dc.publisher.place | Switzerland | - |