OBJECTIVES : Heavy costs associated with the treatment of unspecified ulcerative colitis necessitate the choice of drugs that provide the optimal treatment outcomes within the existing budget constraints. In this study, we compared the multimatrix (MMX) delivery type versus time-dependent delivery of mesalazine for treatment of unspecified ulcerative colitis in terms of their clinical and economic effectiveness.

METHODS : A review of clinical effectiveness was conducted using a sensitive search strategy. 5 high-quality trials identified and used to inform clinical effectiveness parameters in the model. The economic assessment involved the construction of a Markov model comparing the two delivery types over both a short-term (5 years) and a long-term horizon (30 years) using local treatment guidelines and costs, an additional budget impact analysis and a sensitivity analysis of model parameters. The exchange rate used is dated by June 2019 according to the current market rate in Kazakhstan.

RESULTS : According to the model, MMX delivery of mesalazine as first-line therapy for unspecified ulcerative colitis was found to be the dominant therapy compared to time-dependent delivery, producing better outcomes at lower costs (additional 0.015 QALY) and averted costs of 193662 KZT (504.32 USD) per patient in the 5-year model, additional 0.038 QALY and averted costs of 1066659 KZT (2777.7 USD) per patient in the 30-year model). MMX mesalazine was associated with a longer remission stage and fewer relapses. The model was found to be sensitive to MMX mesalazine treatment response period, probability of progression to remission on MMX mesalazine and treatment-related costs.

CONCLUSIONS : Using the MMX delivery of mesalazine in favor of time-dependent delivery for the treatment of unspecified ulcerative colitis appears to be a cost-effective option in the context of healthcare system of Kazakhstan, with potentially improved outcomes and considerable healthcare budget savings.