The Efficacy And Safety Of Febuxostat In Hyperuricemic Patients With Gout: The Meta-analysis And Cost-effectiveness Analysis

Objectives:To evaluate the efficacy and safety of febuxostat for the treatment in hyperuricemic patients with gout,and the cost-effectiveness analysis by using decision tree and Markov model.Methods:Meta analysis: randomize controlled trials(RCTs)of febuxostat were searched from the electronic databases include PubMed,Embase,Cochrane Library,CNKI and CBM(from January 2005 to June 2016).Two reviewers independently selected studies,assessed the quality,and extracted data.The data were analyzed by the RevMen 5.3 of the Cochrane Collaboration.Decision tree: use the data from the RCT to build the decision tree,to evaluate the cost-effectiveness analysis of febuxostat in short-term.Markov model: A Markov model of 3-year time horizon was established by TreeAge Pro 2011,using costs,utility value and clinical outcome from references.Result:Meta analysis: 11 RCTs included 6080 patients were evaluated for the analysis.A higher proportion of patients achieved a serum uric acid(sUA)less than 6.0mg/dl at the last 3 monthly visits(RR=1.90,95%CI:1.38-2.63,P<0.0001)and the last visit(RR=1.65,95%CI:1.34-2.02,P<0.0001)in the febuxostat group compared with the allopurinol group.The percentage change in sUA concentration from baseline at last visit was higher in febuxostat group and febuxostat has a dose escalation effect.The risk of adverse events has no significant differences in two groups.A higher proportion of American patients achieved the sUA less then 6.0mg/dl compared to Chinese patients in febuxostat group,but the incidence of adverse events was lower in Chinese patients.Decisin tree: In 24 weeks treatment period,the cost and effectiveness febuxostat was ￥10422.80 and 0.42 in febuxostat,and the allopurinol group was ￥1935.28 and0.34,the ICER(￥106094)was lower than the willingness-to-pay threshold(￥148053).Markov model : In 3-year treatment period,the cost and effectiveness of febuxostat group was ￥2160.02/QALY,and the allopurinol group was ￥121.33/QALY,the ICER(￥206879.17)was higher than the willingness-to-pay threshold(￥148053).Conclusion: Febuxostat was more effective in reducing sUA in in hyperuricemic patients with gout compared with allopurinol.The incidence of adverse events of febuxostat was lower then allopurinol.Differences of the efficacy and safety were existed between Chinese and American patients using febuxostat.In short-term treatment period,Febuxostat therapy is a cost-effective treatment.In long-term treatment period,allopurinol therapy is a cost-effective treatment.Therefore,Using febuxostat in the initial period of urate-liwering therapy,and combining febuxostat and allopurinol in long-term treatment probably is a suitable therapy in treating hyperuricemic patients with gout...