Background/Purpose: Prophylaxis of acute gout flares when commencing urate lowering therapy is recommended by international guidelines. Whether this is a cost-effective intervention is currently unknown. Colchicine was awarded orphan drug status by the US Food and Drug Administration in 2009 and the price increased from 9 cents per tablet to $5 per tablet (Kesselheim, 2015). Therefore, the economics of using colchicine for all of its indications altered substantially. 

To perform a cost effectiveness analysis of co-prescribing colchicine when initiating urate lowering therapy for gout using both a United States healthcare system input model and an Australian healthcare system cost input model.

Methods: This cost-effectiveness analysis was completed from the point of view of the third-party payer (This therefore excluded costs such as the cost of the patient driving to their doctor or the hospital). We used a two decision-tree with one arm commencing allopurinol with no colchicine prophylaxis and the other with colchicine prophylaxis. Model inputs were drawn from published literature, where available.  We completed univariate and probabilistic sensitivity analysis to confirm the robust nature of the modelling. The time frame for the model was 6 months.

Results: In the US model, the colchicine prophylaxis arm resulted in a cost of US$1109 and 0.49 quality adjusted life-years (QALYs).  This was cost-effective compared to placebo (cost of US$536 and 0.47 QALYs, Incremental cost-effectiveness ratio of $25,666 per QALY gained).  In the Australian model the colchicine arm dominated placebo (AUD228 in colchicine arm vs. AUD523 in placebo) due to lower colchicine cost.  Univariate and probability sensitivity analysis demonstrated that results were robust to changes in input parameters, but were most sensitive to cost of colchicine and the rate of reduction of flares from colchicine treatment.  In probabilistic sensitivity analysis, the probability of colchicine prophylaxis being the most cost-effective option was 78% in the US and 99% in Australian setting, at a willingness-to-pay threshold of $50,000 per QALY gained.

Conclusion: Colchicine prophylaxis of gout flares whilst commencing allopurinol in gout appears to be cost effective both in the US healthcare system with elevated unit cost for colchicine and in the Australian healthcare system where the unit cost of colchicine is substantially lower.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/colchicine-prophylaxis-of-gout-flares-when-commencing-allopurinol-is-very-cost-effective-a-health-economic-analysis/