Urate monitoring pays dividends in gout management – but one thing is missing

Biannual serum urate monitoring can be a cost effective intervention in gout management, according to a cost-utility analysis of Australian and New Zealand data.

However the finding is based on patients being treated to target initially – a practice that is not being done particularly well.

Rheumatologist Dr Philip Robinson from the University of Queensland and Royal Brisbane and Women’s Hospital told the limbic only about one in five patients were treated to a target serum urate.

“So gout care in Australia and around the world is actually terrible as most people are not treated down to target. They are treated with fixed doses of allopurinol – 300mg – and often they don’t reach target so their flares don’t go away.”

“So you can see we’re a long way from being able to implement monitoring if we aren’t even treating people properly.”

The study modeled no serum monitoring versus biannual and annual monitoring while considering costs including tests, medications and management of flares at home and in hospital.

Monitoring serum urate was only incrementally more expensive than no monitoring (range $6,974 to $7,298) and there were gains to be made.

“All we have to do is increase adherence by about 3% and we start saving money and we start improving quality of life. So the paper as modeled demonstrates small differences but the differences are significant and so if this pans out in a real life situation, if we are able to get an increase in adherence, then everyone wins. People have a better quality of life and the system – both patients and funders – save money.”

The study also determined that biannual monitoring was a more cost-effective option than annual monitoring.

Dr Robinson said the assumptions made in the analysis were extremely conservative and it served well as a proof of concept for a clinical study.

“It looks like an intervention as simple as screening serum urate is actually a really good thing to implement.”

“Once people are at target, if you monitor them and you feed that information back to the patients, and that leads to an increase in adherence, then that is likely to decrease flares and save the whole system money.”

“Anything we can do to encourage people to take their medication is good.”

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