dc.contributor.author |
Robinson, Philip C |
en |
dc.contributor.author |
Dalbeth, Nicola |
en |
dc.contributor.author |
Donovan, Peter |
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dc.date.accessioned |
2018-10-11T02:40:58Z |
en |
dc.date.issued |
2018-05 |
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dc.identifier.issn |
0315-162X |
en |
dc.identifier.uri |
http://hdl.handle.net/2292/40780 |
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dc.description.abstract |
OBJECTIVE:The 2012 American College of Rheumatology gout management guidelines recommend monitoring serum urate (SU) every 6 months after target SU has been achieved. Our objective was to determine through modeling whether this testing would be cost-effective, considering financial cost, quality of life, and estimated change in adherence. METHODS:A cost-utility analysis was completed with a 3-arm model: (1) no regular urate monitoring; (2) annual urate monitoring; and (3) biannual urate monitoring. Inputs to the model for health-related quality of life, flare rate, and treatment location were drawn from the medical literature and modeled over a lifetime horizon. RESULTS:No monitoring was the least costly (Australian$6974) but least effective [13.51 quality-adjusted life-yrs (QALY)], while annual urate monitoring [A$7117; 13.53 QALY; incremental cost-effectiveness ratio (ICER) A$13,678/QALY gained] and biannual monitoring [A$7298; 13.54 QALY; ICER A$15,420 per QALY gained] were both cost-effective alternatives in base case analysis. Sensitivity analysis on both an individual component level and a probabilistic sensitivity analysis (PSA) demonstrated that the result was robust to changes in input variables. An improvement in adherence of ≥ 3.5% with biannual monitoring was all that was required to demonstrate cost-effectiveness. In PSA, the probability of biannual monitoring was 78%, no monitoring was 20%, and annual monitoring was 2%. CONCLUSION:The results suggest that biannual SU monitoring after attaining target SU is the most cost-effective, compared with no testing and annual testing. |
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dc.format.medium |
Print-Electronic |
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dc.language |
eng |
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dc.relation.ispartofseries |
The Journal of rheumatology |
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dc.rights |
Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. |
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dc.rights.uri |
https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm |
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dc.subject |
Humans |
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dc.subject |
Gout |
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dc.subject |
Uric Acid |
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dc.subject |
Mass Screening |
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dc.subject |
Quality-Adjusted Life Years |
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dc.subject |
Cost-Benefit Analysis |
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dc.subject |
Australia |
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dc.title |
The Cost-effectiveness of Biannual Serum Urate (SU) Monitoring after Reaching Target in Gout: A Health Economic Analysis Comparing SU Monitoring. |
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dc.type |
Journal Article |
en |
dc.identifier.doi |
10.3899/jrheum.170199 |
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pubs.issue |
5 |
en |
pubs.begin-page |
697 |
en |
pubs.volume |
45 |
en |
dc.rights.holder |
Copyright: The author |
en |
dc.identifier.pmid |
29449500 |
en |
pubs.end-page |
704 |
en |
pubs.publication-status |
Published |
en |
dc.rights.accessrights |
http://purl.org/eprint/accessRights/RestrictedAccess |
en |
pubs.subtype |
Journal Article |
en |
pubs.elements-id |
728236 |
en |
pubs.org-id |
Medical and Health Sciences |
en |
pubs.org-id |
School of Medicine |
en |
pubs.org-id |
Medicine Department |
en |
pubs.record-created-at-source-date |
2018-02-17 |
en |
pubs.dimensions-id |
29449500 |
en |