Doxycycline compared with prednisolone therapy for patients with bullous pemphigoid: cost-effectiveness analysis of the BLISTER trial.

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    • Corporate Authors:
    • Source:
      Publisher: Oxford University Press Country of Publication: England NLM ID: 0004041 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1365-2133 (Electronic) Linking ISSN: 00070963 NLM ISO Abbreviation: Br J Dermatol Subsets: MEDLINE
    • Publication Information:
      Publication: 2023- : Oxford : Oxford University Press
      Original Publication: Oxford [etc.] Published for the British Association of Dermatologists by Blackwell Scientific Publications [etc.]
    • Subject Terms:
    • Abstract:
      Background: Bullous pemphigoid (BP) is an autoimmune blistering skin disorder associated with significant morbidity and mortality. Doxycycline and prednisolone to treat bullous pemphigoid were compared within a randomized controlled trial (RCT).
      Objectives: To compare the cost-effectiveness of doxycycline-initiated and prednisolone-initiated treatment for patients with BP.
      Methods: Quality-of-life (EuroQoL-5D-3L) and resource data were collected as part of the BLISTER trial: a multicentre, parallel-group, investigator-blinded RCT. Within-trial analysis was performed using bivariate regression of costs and quality-adjusted life-years (QALYs), with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective.
      Results: In the base case, there was no robust difference in costs or QALYs per patient at 1 year comparing doxycycline- with prednisolone-initiated therapy [net cost £959, 95% confidence interval (CI) -£24 to £1941; net QALYs -0·024, 95% CI -0·088 to 0·041]. However, the findings varied by baseline blister severity. For patients with mild or moderate blistering (≤ 30 blisters) net costs and outcomes were similar. For patients with severe blistering (> 30 blisters) net costs were higher (£2558, 95% CI -£82 to £5198) and quality of life poorer (-0·090 QALYs, 95% CI -0·22 to 0·042) for patients starting on doxycycline. The probability that doxycycline would be cost-effective for those with severe pemphigoid was 1·5% at a willingness to pay of £20 000 per QALY.
      Conclusions: Consistently with the clinical findings of the BLISTER trial, patients with mild or moderate blistering should receive treatment guided by the safety and effectiveness of the drugs and patient preference - neither strategy is clearly a preferred use of National Health Service resources. However, prednisolone-initiated treatment may be more cost-effective for patients with severe blistering.
      (© 2017 The Authors. British Journal of Dermatology published by John Wiley & Sons Ltd on behalf of British Association of Dermatologists.)
    • Comments:
      Comment in: Br J Dermatol. 2018 Mar;178(3):810. (PMID: 29205265)
      Comment in: Br J Dermatol. 2018 Mar;178(3):809-810. (PMID: 29205281)
      Comment in: Br J Dermatol. 2018 Feb;178(2):320-321. (PMID: 29441558)
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    • Grant Information:
      HTA/06/403/51 United Kingdom DH_ Department of Health
    • Accession Number:
      0 (Dermatologic Agents)
      9PHQ9Y1OLM (Prednisolone)
      N12000U13O (Doxycycline)
    • Publication Date:
      Date Created: 20170924 Date Completed: 20190422 Latest Revision: 20220129
    • Publication Date:
      20240829
    • Accession Number:
      PMC5813790
    • Accession Number:
      10.1111/bjd.16006
    • Accession Number:
      28940316