Even Costly Febuxostat Combos Found Cost-Effective for Gout

Jutkowitz E, Choi HK, Pizzi LT, Kuntz KM. Cost-Effectiveness of Allopurinol and Febuxostat for the Management of Gout.Annals of Internal Medicine 2014;161:617-626. doi:10.7326/M14-0227. Online Nov 4.

Treating gout with allopurinol is less costly than not treating gout at all, according to this analysis. Although allopurinol-febuxostat sequential therapy proves pricier,  it is still cost-effective under certain circumstances, according to the analysts.

The 2012 American College of Rheumatology gout guidelines call for cost-effectiveness analyses, and this study responds to that call.

Early trials find fixed doses of febuxostat at 80 mg/day superior to fixed doses of allopurinol at 300 mg/day. This works to the disadvantage of allopurinol, which is sometimes given not at a fixed dose, but at a sufficient dose (≤800 mg/day) to target a serum uric acid level of 360 μmol/L.

This cost-effectiveness analysis follows those fixed-dose assumptions. The authors calculate costs and quality-adjusted life-years (QALY) of allopurinol and febuxostat as single treatments, allopurinol-febuxostat sequential treatment, febuxostat-allopurinol sequential treatment, and no treatment.

The models evaluate fixed-dose (febuxostat 80 mg/day, allopurinol 300 mg/day) and dose escalation (febuxostat ≤120 mg/day, allopurinol ≤800 mg/day).

They note that dose-escalation allopurinol-febuxostat sequential therapy is more expensive, but more effective than dose-escalation allopurinol treatment. As a result, the authors deem the combination regimen cost-effective at an accepted willingness-to-pay threshold of $109,000 per QALY.