Cost Effectiveness of Emedastine versus Levocabastine in the Treatment of Allergic Conjunctivitis in 7 European Countries
作者:Carlos Gouveia Pinto、Antoine Lafuma、Francis Fagnani、Mark J.C. Nuijten、Gilles Berdeaux
DOI:10.2165/00019053-200119030-00004
日期:——
Objective: To assess the cost effectiveness of emedastine, a new antihistamine, versus levocabastine in the treatment of acute allergic conjunctivitis (AAC) in Belgium, France, Germany, The Netherlands, Norway, Portugal and Sweden. Design and setting: Randomised double-blind multicountry clinical trial followed by economic modelling from the treatment provider perspective. Patients: A total of 221 patients (109 emedastine, 112 levocabastine) with AAC were included. Methods: The clinical trial compared the efficacy and safety of emedastine 0.05% and levocabastine 0.05%, both twice daily, for 42 days, using ocular redness, itching, days without symptoms and clinical failure as outcome measures. The cost of first-line treatment failure, including visits, drugs and laboratory examinations, was established in each country from a panel of ophthalmologists and general practitioners. Full sensitivity analyses were conducted. Results: From day 7 to 42, patients treated with emedastine had less itching (p < 0.001) and less redness (p < 0.001). The failure rate was 10% less (p < 0.02) with emedastine and patients treatedwith emedastine had an incremental 8.5 days (p < 0.01) without symptoms. Emedastine and levocabastine were equally well tolerated. In all European countries, the cost of failurewas lower with emedastine. Emedastine was found to be economically dominant relative to levocabastine, i.e. more effective and less expensive, in Belgium, Germany, Portugal and Sweden; in France, The Netherlands and Norway the incremental cost was low (less than 1 euro per additional symptom-free day). Conclusion: Through a model based on a randomised clinical trial and cost estimates of treatment failure derived from practitioner interviews, emedastine is a cost-effective treatment of AAC.
目的评估在比利时、法国、德国、荷兰、挪威、葡萄牙和瑞典治疗急性过敏性结膜炎 (AAC) 时,新型抗组胺药物依美司汀与左卡巴斯汀的成本效益。设计与环境:随机双盲多国临床试验,然后从治疗提供者的角度进行经济建模。患者:共纳入221例AAC患者(109例依美司汀,112例左卡巴斯汀)。研究方法该临床试验比较了依马斯汀 0.05% 和左卡巴斯汀 0.05% 的疗效和安全性,两种药物均为每日两次,疗程均为 42 天,以眼红、瘙痒、无症状天数和临床失败为结局指标。由眼科医生和全科医生组成的专家小组确定了每个国家一线治疗失败的成本,包括就诊、药物和实验室检查费用。进行了全面的敏感性分析。结果显示从第 7 天到第 42 天,接受依美司汀治疗的患者瘙痒较少(p < 0.001),发红较少(p < 0.001)。依美司汀治疗的失败率降低了 10%(p <0.02),接受依美司汀治疗的患者无症状的时间增加了 8.5 天(p <0.01)。依美司汀和左卡巴斯汀的耐受性同样良好。在所有欧洲国家,依美司汀治疗失败的成本较低。在比利时、德国、葡萄牙和瑞典,依美司汀的经济效益优于左卡巴斯汀,即疗效更好,价格更低;在法国、荷兰和挪威,依美司汀的增量成本较低(每增加一天无症状的时间,增量成本不到1欧元)。结论通过基于随机临床试验的模型和对从业人员的访谈得出的治疗失败成本估算,依美司丁治疗 AAC 具有成本效益。