The economics of mesalazine in active ulcerative colitis and maintenance in the Netherlands

Background: In this study we investigate the costs and benefits of topical mesalazine combined with oral mesalazine therapy for active ulcerative colitis (UC), and once daily (OD) mesalazine 2 grams versus twice daily (BID) for maintaining UC remission. Methods: Two decision analytic models were constructed to evaluate treatment costs and quality-adjusted life years (QALYs) associated with mesalazine. The first model explored 4 g oral mesalazine in combination with 1 g topical mesalazine during active UC compared with 4 g oral mesalazine monotherapy for achieving clinical remission. The second model compared remission rates at one year for OD 2 g oral mesalazine compared with BID 1 g adjusted for compliance. All direct costs were obtained from established treatment costs in the Netherlands. Results: The average cost of treatment to transition an active UC patient into remission using oral plus topical mesalazine or oral mesalazine monotherapy was (sic)2207 (95% CI: (sic)1402 to (sic)3332) and (sic)2945 (95% CI: (sic)1717 to (sic)4592), respectively. The annual average cost-saving of adding topical mesalazine delivered for four weeks during active UC was (sic)738. The average annual costs of maintenance of remission with OD and BID therapy were (sic)1293 (95% CI: (sic)1062 to (sic)1496) and (sic)1502 (95% CI: (sic)1262 to 1708), respectively with an annual average per person savings of (sic)209. Conclusion: Topical mesalazine during acute UC flares results in lower costs due to reduced healthcare consumption attributed to faster symptom resolution. Furthermore, as a result of lower costs and modest QALY gains, maintenance therapy using OD mesalazine is the dominant treatment option if compared with BID mesalazine