Introduction We developed a Markov model for ulcerative colitis that calculated the costs of two different treatment strategies for 1000 patients and healthcare providers and ran the model over a ten year cycle to evaluate each treatment arm.
Methods Healthcare costs were calculated from the published study of costs of ulcerative colitis at Aintree University Hospital, Liverpool, UK. Effects were quantified with the EQ-5D visual analogue scale and Work Productivity and Activity Impairment (WPAI) study.
Lost income for patients was calculated assuming that the patient was self employed, earning the national average wage and had no sickness benefits.
Results Cohort simulation is used to present the results. At the end of exercise, 277 patients were in the phase of remission in ASA continuing arm and 232 patients were in the same phase in ASA discontinuing arm.
Total costs to the healthcare providers for providing treatment to the patients were found to be £15,390,139.81 (discounted-£12,825,018.45) for ASA continuing arm and that for ASA discontinuing arm were £12,911,557.43 (discounted-£10,752,633.35). These costs were incurred to gain QALYs of 31,682.14 (discounted-26713.79) for the ASA continuing arm and of 31,307.73 (discounted-26,405.89 for ASA discontinuing arm).
Primary outcome in terms of ICER (Incremental Cost-Effectiveness Ratio) is £6730.55 per QALY (acceptable range <£20,000–30,000). Secondary outcomes such as Discounted total earnings lost due to illness and Discounted total earnings affected due to work impairment were found to be in favour of ASA continuation by 19.43% (£3.7 million) and 11.15% (£7.8 million) in favour of ASA continuing arm.
Sensitivity analysis was conducted to challenge both the cost and effect assumptions. CEAC (Cost Effectiveness Acceptability Curve) revealed the probability of 1 is reached with the cost-effectiveness acceptability limit of £40,000 ceiling limit.
Conclusion Markov models have been used extensively to study the cost-effectiveness of healthcare interventions in chronic diseases.
Our Markov model considered costs for both patients and healthcare providers, rather than solely considering the costs for healthcare providers.
Results not only revealed the cost-effectiveness of ASA for the healthcare provider but also potential benefits for the broader economy.
Disclosure of Interest None Declared.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.