Table 3. The results of the reviewed studies .
| Author, year/ Re | Direct health-related costs | Intervention | Comparator | ICER | Results | ||
| DC1 | CAE2 | NPC3 | |||||
| Stephen M. Beard /2013/ (26) | * | * | * | febuxostat 80 mg/120 mg as a second-line treatment after allopurinol (allopurinol-febuxostat sequential therapy) |
allopurinol 300 mg alone | £3,578 per QALY | The best first-line option for lowering serum uric acid is Allopurinol at 300 mg/day, and, if ineffective, treatment strategy can switch to Febuxostat at 80 or 120 mg/day. Febuxostat at 80 or 120 mg/day is the cost-effective strategy second-line treatment, and its ICER per QALY is below the threshold ($10,000). |
| Pranav K. Gandhi/ 2014/ (19) | * | * | Febuxostat 80 mg alone | Allopurinol 300 mg alone | $6,322 per achievement of a sUA level < 6 mg/dL) | From a payer’s perspective, Febuxostat is more cost-effective than Allopurinol and its ICER per treatment success is below the threshold ($10,000). | |
| Eric Jutkowitz/ 2014/ (20) | * | * | Dose-escalation allopurinol-febuxostat sequential therapy |
Allopurinol alone | $39 400 per QALY | Dose-escalation Febuxostat and dose-escalation Febuxostat-Allopurinol sequential therapy are not cost-effective strategies, though they may be highly effective. However, Febuxostat is a suitable second-line option, and dose-escalation. | |
| Dose-escalation febuxostat- allopurinol sequential therapy | $563 800 per QALY | ||||||
| Dose-escalation of Febuxostat (<120 mg) |
$ 322 800 per QALY | ||||||
| Michele Meltzer/ 2012/ (27) | * | * | * | Allopurinol 300 mg -febuxostat 80-240 mg sequential therapy |
Allopurinol alone 300 mg | Not mentioned | Allopurinol is a suitable first-line strategy, but if it is ineffective in lowering serum urate levels in some patients, Febuxostat is prescribed as the second-line option. |
| Lee J. Smolen/2015/ (22) | * | * | * | Febuxostat 40–80 mg alone | Allopurinol 100–300 mg alone | $5377 (<$10,000) per patient reaching target sUA $1773 (<$10,000) per flare avoided $221,795 per incident CKD1 avoided $29,063 per CKD $36,018 per progression to CKD 3/4 avoided $71,426 per progression to CKD 5 Avoided $214,277 per incident T2DM avoided $217,971 per death avoided |
Compared to Allopurinol, Febuxostat is a more cost-effective treatment in achieving target sUA and preventing gout flares and its ICER for these two measures is below the threshold ($10,000). |
| F. Perez-Ruiz/ 2016/ (9) | * | Alo 300 → Feb 80 → Feb 120 | Allopurinol 300 mg alone | € 5,268 per QALY | Febuxostat (whether by itself or as a sequential treatment before or after Allopurinol) is a cost-effective option and its ICER per QALY is below the commonly cited efficiency threshold for Spain (30,000€/QALY). | ||
| Feb 80 → Feb 120 → Alo 300 | € 7,129 per QALY | ||||||
| Feb 80 → Feb120 | € 9,737 per QALY | ||||||
1. Drug Costs, 2. Costs Associated with Adverse Events, 3. Nonpharmacologic Costs, 4. Chronic Kidney Disease