Ciclosporin compared to prednisolone therapy for patients with pyoderma gangrenosum: cost-effectiveness analysis of the STOP GAP trial
Background Pyoderma gangrenosum (PG) is a painful, ulcerating skin disease with poor evidence for management. Prednisolone and ciclosporin are the most commonly used treatments, although not previously compared within a randomised controlled trial (RCT) Objectives To compare the cost-effectiv...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Published: |
Wiley
2017
|
| Online Access: | https://eprints.nottingham.ac.uk/43286/ |
| _version_ | 1848796654763769856 |
|---|---|
| author | Mason, J.M. Thomas, K.S. Ormerod, A.D. Craig, F.E. Mitchell, E. Norrie, J. Williams, H.C. |
| author_facet | Mason, J.M. Thomas, K.S. Ormerod, A.D. Craig, F.E. Mitchell, E. Norrie, J. Williams, H.C. |
| author_sort | Mason, J.M. |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | Background
Pyoderma gangrenosum (PG) is a painful, ulcerating skin disease with poor evidence for management. Prednisolone and ciclosporin are the most commonly used treatments, although not previously compared within a randomised controlled trial (RCT)
Objectives
To compare the cost-effectiveness of ciclosporin and prednisolone-initiated treatment for patients with PG.
Methods
Quality-of-life (EuroQoL EQ-5D-3L) and resource data were collected as part of the STOP-GAP trial: a multicentre, parallel-group, observer-blind RCT. Within-trial analysis used bivariate regression of costs and QALYs, with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective.
Results
In the base case analysis, when compared with prednisolone, ciclosporin was cost-effective due to a reduction in costs (net cost: -£1160; 95%CI: (-2991 to 672) and improvement in quality of life (net QALYs: 0.055; 95%CI: 0.018 to 0.093). However, this finding appears driven by a minority of patients with large lesions (≥20cm2) (net cost: -£5310; 95%CI: -9729 to -891; net QALYs: 0.077; 95%CI: 0.004 to 0.151). The incremental cost-effectiveness of ciclosporin for the majority of patients with smaller lesions was £23,374/QALY although the estimate is imprecise: the probability of being cost-effective at a willingness to pay of £20,000/QALY was 43%.
Conclusions
Consistent with the clinical findings of the STOP-GAP trial, patients with small lesions should receive treatment guided by the side effect profiles of the drugs and patient preference - neither strategy is clearly a preferred use of NHS resources. However, ciclosporin-initiated treatment may be more cost-effective for patients with large lesions. |
| first_indexed | 2025-11-14T19:51:25Z |
| format | Article |
| id | nottingham-43286 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:51:25Z |
| publishDate | 2017 |
| publisher | Wiley |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-432862020-05-04T19:54:08Z https://eprints.nottingham.ac.uk/43286/ Ciclosporin compared to prednisolone therapy for patients with pyoderma gangrenosum: cost-effectiveness analysis of the STOP GAP trial Mason, J.M. Thomas, K.S. Ormerod, A.D. Craig, F.E. Mitchell, E. Norrie, J. Williams, H.C. Background Pyoderma gangrenosum (PG) is a painful, ulcerating skin disease with poor evidence for management. Prednisolone and ciclosporin are the most commonly used treatments, although not previously compared within a randomised controlled trial (RCT) Objectives To compare the cost-effectiveness of ciclosporin and prednisolone-initiated treatment for patients with PG. Methods Quality-of-life (EuroQoL EQ-5D-3L) and resource data were collected as part of the STOP-GAP trial: a multicentre, parallel-group, observer-blind RCT. Within-trial analysis used bivariate regression of costs and QALYs, with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective. Results In the base case analysis, when compared with prednisolone, ciclosporin was cost-effective due to a reduction in costs (net cost: -£1160; 95%CI: (-2991 to 672) and improvement in quality of life (net QALYs: 0.055; 95%CI: 0.018 to 0.093). However, this finding appears driven by a minority of patients with large lesions (≥20cm2) (net cost: -£5310; 95%CI: -9729 to -891; net QALYs: 0.077; 95%CI: 0.004 to 0.151). The incremental cost-effectiveness of ciclosporin for the majority of patients with smaller lesions was £23,374/QALY although the estimate is imprecise: the probability of being cost-effective at a willingness to pay of £20,000/QALY was 43%. Conclusions Consistent with the clinical findings of the STOP-GAP trial, patients with small lesions should receive treatment guided by the side effect profiles of the drugs and patient preference - neither strategy is clearly a preferred use of NHS resources. However, ciclosporin-initiated treatment may be more cost-effective for patients with large lesions. Wiley 2017-12 Article PeerReviewed Mason, J.M., Thomas, K.S., Ormerod, A.D., Craig, F.E., Mitchell, E., Norrie, J. and Williams, H.C. (2017) Ciclosporin compared to prednisolone therapy for patients with pyoderma gangrenosum: cost-effectiveness analysis of the STOP GAP trial. British Journal of Dermatology, 177 (6). pp. 1527-1536. ISSN 1365-2133 http://onlinelibrary.wiley.com/doi/10.1111/bjd.15561/abstract doi:10.1111/bjd.15561 doi:10.1111/bjd.15561 |
| spellingShingle | Mason, J.M. Thomas, K.S. Ormerod, A.D. Craig, F.E. Mitchell, E. Norrie, J. Williams, H.C. Ciclosporin compared to prednisolone therapy for patients with pyoderma gangrenosum: cost-effectiveness analysis of the STOP GAP trial |
| title | Ciclosporin compared to prednisolone therapy for patients with pyoderma gangrenosum: cost-effectiveness analysis of the STOP GAP trial |
| title_full | Ciclosporin compared to prednisolone therapy for patients with pyoderma gangrenosum: cost-effectiveness analysis of the STOP GAP trial |
| title_fullStr | Ciclosporin compared to prednisolone therapy for patients with pyoderma gangrenosum: cost-effectiveness analysis of the STOP GAP trial |
| title_full_unstemmed | Ciclosporin compared to prednisolone therapy for patients with pyoderma gangrenosum: cost-effectiveness analysis of the STOP GAP trial |
| title_short | Ciclosporin compared to prednisolone therapy for patients with pyoderma gangrenosum: cost-effectiveness analysis of the STOP GAP trial |
| title_sort | ciclosporin compared to prednisolone therapy for patients with pyoderma gangrenosum: cost-effectiveness analysis of the stop gap trial |
| url | https://eprints.nottingham.ac.uk/43286/ https://eprints.nottingham.ac.uk/43286/ https://eprints.nottingham.ac.uk/43286/ |