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P325. The budgetary impact of 2 g mesalazine for the treatment of mild to moderate ulcerative colitis

I. Lovelace1, E. Tate2, S. Knapp3, J. Masure4, G. Shields2, 1Ferring Pharmaceuticals, UK Medical, West Drayton, United Kingdom, 2BresMed, Health Economics Consulting, Sheffield, United Kingdom, 3Ferring Pharmaceuticals, UK Gastroenterology, West Drayton, United Kingdom, 4Ferring Pharmaceuticals, Global Gastroenterology Department, Saint-Prex, Switzerland

Background

Mesalazine acts by reducing inflammation in the intestine caused by ulcerative colitis (UC) and is indicated for the induction of remission and the treatment of patients with UC [1].

Non-adherence is common in UC patients, partly due to a high pill burden [2]. Lack of adherence increases the risk of relapse which increases the risk of a hospital admission [1]. Patients with inflammatory bowel disease have a higher risk of developing colon cancer; however studies have shown that those who adhere to treatment may have a reduced risk [3]. Patients who receive 2g oral mesalazine once daily are more likely to adhere to treatment when compared to patients with a higher pill burden [4].

The objective of the study was to estimate the financial implications resulting from the introduction of a 2g formulation of mesalazine for the treatment of mild to moderate UC from the perspective of the UK NHS.

Methods

A 5 year budget impact model was developed focusing on some of the key financial drivers of UC patient care; drug acquisition costs, costs associated with re-inducing remission, unplanned hospital admission costs and colon cancer treatment costs.

The model compares the 2g formulation of mesalazine to the current treatment mix for UC patients. Assumptions had to be made in order to simplify the model and populate default values. Adherence and relapse rates were taken from published papers. Costs and the rate of hospitalisation were taken from national statistics. The model is adaptable and inputs can be adjusted.

For this example, the population was assumed to be 226,000, the average CCG size. The UC population was calculated using a prevalence rate of 243.4 per 100,000 and an incidence rate of 13.9 per 100,000 [5].

Results

The model estimated that the introduction of the 2g formulation of mesalazine would result in a cost saving of £126,055 in an average sized CCG in year 1. This is an average saving of £217 per UC patient. The main driver of cost savings was a reduction in drug acquisition costs, partly due to reduced numbers of relapsing patients who require higher doses to re-induce remission. Cost savings increase over the time horizon with an estimated cumulative saving of £698,376 by year 5.

Conclusion

The introduction of the 2g mesalazine formulation may lead to a cost saving in the UK when compared with the current treatment mix. A potential increase in adherence could create cost savings due to a reduction in costs of drug acquisition, fewer relapsing patients, lower hospital admissions and a reduction in colon cancer cases amongst UC patients.

1. Ferring Pharmaceuticals Ltd (2012), Pentasa Summary of Product Characteristics. www.medicines.org.uk/emc/medicine/668/spc

2. Kane SV (2006), Systematic review: adherence issues in the treatment of ulcerative colitis, Aliment Pharmacol Ther; 23: 577–585.

3. Eaden J et al. (2000), Colorectal cancer prevention in ulcerative colitis: a case–control study, Aliment Pharmacol Ther; 14: 145–153.

4. Dignass AU et al. (2009), Mesalamine once daily is more effective than twice daily in patients with quiescent ulcerative colitis, Clin Gastroenterol Hepatol; 7(7): 762–9.

5. Rubin GP et al. (2000), Infammatory bowel disease: epidemiology and management in an English general practice population, Aliment Pharmacol Ther; 14: 1553–1559.