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 21 October 2017

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News

Topical steroids vs dietary elimination for treatment of eosinophilic esophagitis

This month's Clinical Gastroenterology & Hepatology examines cost utility analysis of topical steroids compared with dietary elimination for treatment of eosinophilic esophagitis.

News image

Topical corticosteroids or dietary elimination are recommended as first-line therapies for eosinophilic esophagitis, but data to directly compare these therapies are scant.

Dr Evan Dellon and colleagues from North Carolina, USA performed a cost utility comparison of topical corticosteroids and the 6-food elimination diet (SFED) in treatment of eosinophilic esophagitis, from the payer perspective.

The researchers used a modified Markov model based on current clinical guidelines, in which transition between states depended on histologic response simulated at the individual cohort-member level.

Simulation parameters were defined by systematic review and meta-analysis to determine the base-case estimates and bounds of uncertainty for sensitivity analysis.

SFED was more effective and less expensive than topical fluticasone
Clinical Gastroenterology & Hepatology

The team found that topical fluticasone was about as effective as SFED but more expensive at a 5-year time horizon.

The researchers noted that SFED was more effective and less expensive than topical fluticasone and topical budesonide in the base-case scenario.

Probabilistic sensitivity analysis revealed little uncertainty in relative treatment effectiveness.

The researchers observed a somewhat greater uncertainty in the relative cost of treatments.

Most simulations found SFED to be less expensive.

Dr Dellon's team comments, "In a cost utility analysis comparing topical corticosteroids and SFED for first-line treatment of eosinophilic esophagitis, the therapies were similar in effectiveness."

"SFED was on average less expensive, and more cost effective in most simulations, than topical budesonide and topical fluticasone, from a payer perspective and not accounting for patient-level costs or quality of life."

Clin Gastroenterol Hepatol 2017: 15(6): 841–849.e1
15 June 2017

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