Colchicine prophylaxis of gout flares proves to be good value

The use of low-dose colchicine to prevent flares on initiation of urate-lowering therapy is cost effective in Australia if not the US, a rheumatologist has told the 2019 APLAR-ARA meeting in Brisbane.

Dr Phil Robinson of the Royal Brisbane and Women’s Hospital and University of Queensland said that guidelines recommended the use of flare prophylaxis because it was clinically effective.

However a significant price hike for the drug in the US market in recent years had raised questions about whether patients and third party payers were getting value for money.

“We had developed an interest in this because it often puts patients off when they flare on starting their urate-lowering therapy. And potentially people were not going to use colchicine so much in the US because of that increased cost,” he told the limbic.

“Would people have more problems with allopurinol? Are they going to have poorer control? Are they going to have worse gout because of this outcome? How has that one change influenced the whole management of gout?”

Dr Robinson said the cost-effectiveness analysis was based on the findings from a 2004 randomised controlled trial that colchicine could reduce the frequency and severity of acute flares.

He said about 1.3% of gout flares resulted in a hospital admission.

The cost-effectiveness study therefore considered potential savings from fewer Medicare visits, medications and hospital admissions would outweigh the direct costs of using colchicine.

It found in the US, where the cost of colchicine would be about $1,000, the incremental cost-effectiveness ratio (ICER) was an acceptable $25,000.

In Australia, where the medication cost was about $200, colchicine dominated over the alternative of no colchicine.

Dr Robinson said the probability of colchicine being cost effective in the US was 78% vs 99% in Australia.

“It is clinically efficacious but also cost effective when initiating allopurinol,” he said.

Even with the increased cost that has been caused by the Orphan Drug Program in the US, it was still worth paying about $5 a tablet because of all the cost savings from flares and hospital admissions.

He said colchicine had some potential side effects such as diarrhoea but its use was well supported in Australia at the secondary care level.

“I suspect that the rates are much less in primary care,” said Dr Robinson.


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