Economic evaluation of using daily prednisolone versus placebo at the time of an upper respiratory tract infection for the management of children with steroid-sensitive nephrotic syndrome: a model-based analysis

PREDNOS Collaborative Group; NIHR Medicines for Children Research Network Nephrology Clinical Studies Group; Nafsika Afentou; Emma Frew; Samir Mehta; Natalie Rowland; Rebecca Woolley; Elizabeth Brettell; Adam Khan; David Milford; Detlef Bockenhauer; Moin A  Saleem; Angela S   Hall; Ania  Koziell; Heather Maxwell; Shivaram  Hegde; Eric R  Finlay; Rodney D Gilbert; Caroline Jones; Karl McKeever; Wendy Cook; Nicholas JA  Webb; Martin T  Christian

doi:10.1007/s41669-022-00334-6

Economic evaluation of using daily prednisolone versus placebo at the time of an upper respiratory tract infection for the management of children with steroid-sensitive nephrotic syndrome: a model-based analysis

PREDNOS Collaborative Group, NIHR Medicines for Children Research Network Nephrology Clinical Studies Group, Nafsika Afentou, Emma Frew, Samir Mehta, Natalie Rowland, Rebecca Woolley, Elizabeth Brettell, Adam Khan, David Milford, Detlef Bockenhauer, Moin A Saleem , Angela S Hall, Ania Koziell, Heather Maxwell, Shivaram Hegde , Eric R Finlay, Rodney D Gilbert, Caroline Jones, Karl McKeeverWendy Cook, Nicholas JA Webb, Martin T Christian

Research output: Contribution to journal › Article › peer-review

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Abstract

Background
Childhood steroid-sensitive nephrotic syndrome is a frequently relapsing disease with significant short- and long-term complications, leading to high healthcare costs and reduced quality of life for patients. The majority of relapses are triggered by upper respiratory tract infections (URTIs) and evidence shows that daily low-dose prednisolone at the time of infection may reduce the risk of relapse.

Objective
The aim of this study was to assess the cost effectiveness of a 6-day course of low-dose prednisolone at the start of a URTI when compared with placebo.

Methods
A state-transition Markov model was developed to conduct a cost-utility analysis with the outcome measured in quality-adjusted life-years (QALYs). Resource use and outcome data were derived from the PREDNOS2 trial. The analysis was performed from a UK National Health Service perspective and the results were extrapolated to adulthood. Model parameter and structural uncertainty were assessed using sensitivity analyses.

Results
The base-case results showed that administering low-dose prednisolone at the time of a URTI generated more QALYs and a lower mean cost at 1 year compared with placebo. In the long-term, low-dose prednisolone was associated with a cost saving (£176) and increased effectiveness (0.01 QALYs) compared with placebo and thus remained the dominant treatment option. These findings were robust to all sensitivity analyses.

Conclusion
A 6-day course of low-dose prednisolone at the time of a URTI in children with steroid-sensitive nephrotic syndrome has the potential to reduce healthcare costs and improve quality of life compared with placebo.

Original language	English
Pages (from-to)	605-617
Number of pages	13
Journal	PharmacoEconomics
Volume	6
Issue number	4
Early online date	22 Jun 2022
DOIs	https://doi.org/10.1007/s41669-022-00334-6
Publication status	Published - Jul 2022

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PREDNOS Collaborative Group, NIHR Medicines for Children Research Network Nephrology Clinical Studies Group, Afentou, N., Frew, E., Mehta, S., Rowland, N., Woolley, R., Brettell, E., Khan, A., Milford, D., Bockenhauer, D., Saleem , M. A., Hall, A. S., Koziell, A., Maxwell, H., Hegde , S., Finlay, E. R., Gilbert, R. D., Jones, C., ... Christian, M. T. (2022). Economic evaluation of using daily prednisolone versus placebo at the time of an upper respiratory tract infection for the management of children with steroid-sensitive nephrotic syndrome: a model-based analysis. PharmacoEconomics, 6(4), 605-617. Advance online publication. https://doi.org/10.1007/s41669-022-00334-6

PREDNOS Collaborative Group ; NIHR Medicines for Children Research Network Nephrology Clinical Studies Group ; Afentou, Nafsika et al. / Economic evaluation of using daily prednisolone versus placebo at the time of an upper respiratory tract infection for the management of children with steroid-sensitive nephrotic syndrome : a model-based analysis. In: PharmacoEconomics. 2022 ; Vol. 6, No. 4. pp. 605-617.

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title = "Economic evaluation of using daily prednisolone versus placebo at the time of an upper respiratory tract infection for the management of children with steroid-sensitive nephrotic syndrome: a model-based analysis",

abstract = "BackgroundChildhood steroid-sensitive nephrotic syndrome is a frequently relapsing disease with significant short- and long-term complications, leading to high healthcare costs and reduced quality of life for patients. The majority of relapses are triggered by upper respiratory tract infections (URTIs) and evidence shows that daily low-dose prednisolone at the time of infection may reduce the risk of relapse.ObjectiveThe aim of this study was to assess the cost effectiveness of a 6-day course of low-dose prednisolone at the start of a URTI when compared with placebo.MethodsA state-transition Markov model was developed to conduct a cost-utility analysis with the outcome measured in quality-adjusted life-years (QALYs). Resource use and outcome data were derived from the PREDNOS2 trial. The analysis was performed from a UK National Health Service perspective and the results were extrapolated to adulthood. Model parameter and structural uncertainty were assessed using sensitivity analyses.ResultsThe base-case results showed that administering low-dose prednisolone at the time of a URTI generated more QALYs and a lower mean cost at 1 year compared with placebo. In the long-term, low-dose prednisolone was associated with a cost saving (£176) and increased effectiveness (0.01 QALYs) compared with placebo and thus remained the dominant treatment option. These findings were robust to all sensitivity analyses.ConclusionA 6-day course of low-dose prednisolone at the time of a URTI in children with steroid-sensitive nephrotic syndrome has the potential to reduce healthcare costs and improve quality of life compared with placebo.",

author = "{PREDNOS Collaborative Group} and {NIHR Medicines for Children Research Network Nephrology Clinical Studies Group} and Nafsika Afentou and Emma Frew and Samir Mehta and Natalie Rowland and Rebecca Woolley and Elizabeth Brettell and Adam Khan and David Milford and Detlef Bockenhauer and Saleem, {Moin A} and Hall, {Angela S} and Ania Koziell and Heather Maxwell and Shivaram Hegde and Finlay, {Eric R} and Gilbert, {Rodney D} and Caroline Jones and Karl McKeever and Wendy Cook and Webb, {Nicholas JA} and Christian, {Martin T}",

note = "{\textcopyright} 2022. The Author(s).",

year = "2022",

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doi = "10.1007/s41669-022-00334-6",

language = "English",

volume = "6",

pages = "605--617",

journal = "PharmacoEconomics",

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PREDNOS Collaborative Group, NIHR Medicines for Children Research Network Nephrology Clinical Studies Group, Afentou, N , Frew, E , Mehta, S , Rowland, N , Woolley, R , Brettell, E, Khan, A, Milford, D, Bockenhauer, D, Saleem , MA, Hall, AS, Koziell, A, Maxwell, H, Hegde , S, Finlay, ER, Gilbert, RD, Jones, C, McKeever, K, Cook, W, Webb, NJA & Christian, MT 2022, 'Economic evaluation of using daily prednisolone versus placebo at the time of an upper respiratory tract infection for the management of children with steroid-sensitive nephrotic syndrome: a model-based analysis', PharmacoEconomics, vol. 6, no. 4, pp. 605-617. https://doi.org/10.1007/s41669-022-00334-6

Economic evaluation of using daily prednisolone versus placebo at the time of an upper respiratory tract infection for the management of children with steroid-sensitive nephrotic syndrome: a model-based analysis. / PREDNOS Collaborative Group; NIHR Medicines for Children Research Network Nephrology Clinical Studies Group ; Afentou, Nafsika et al.
In: PharmacoEconomics, Vol. 6, No. 4, 07.2022, p. 605-617.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Economic evaluation of using daily prednisolone versus placebo at the time of an upper respiratory tract infection for the management of children with steroid-sensitive nephrotic syndrome

T2 - a model-based analysis

AU - PREDNOS Collaborative Group

AU - NIHR Medicines for Children Research Network Nephrology Clinical Studies Group

AU - Afentou, Nafsika

AU - Frew, Emma

AU - Mehta, Samir

AU - Rowland, Natalie

AU - Woolley, Rebecca

AU - Brettell, Elizabeth

AU - Khan, Adam

AU - Milford, David

AU - Bockenhauer, Detlef

AU - Saleem , Moin A

AU - Hall, Angela S

AU - Koziell, Ania

AU - Maxwell, Heather

AU - Hegde , Shivaram

AU - Finlay, Eric R

AU - Gilbert, Rodney D

AU - Jones, Caroline

AU - McKeever, Karl

AU - Cook, Wendy

AU - Webb, Nicholas JA

AU - Christian, Martin T

PY - 2022/7

Y1 - 2022/7

N2 - BackgroundChildhood steroid-sensitive nephrotic syndrome is a frequently relapsing disease with significant short- and long-term complications, leading to high healthcare costs and reduced quality of life for patients. The majority of relapses are triggered by upper respiratory tract infections (URTIs) and evidence shows that daily low-dose prednisolone at the time of infection may reduce the risk of relapse.ObjectiveThe aim of this study was to assess the cost effectiveness of a 6-day course of low-dose prednisolone at the start of a URTI when compared with placebo.MethodsA state-transition Markov model was developed to conduct a cost-utility analysis with the outcome measured in quality-adjusted life-years (QALYs). Resource use and outcome data were derived from the PREDNOS2 trial. The analysis was performed from a UK National Health Service perspective and the results were extrapolated to adulthood. Model parameter and structural uncertainty were assessed using sensitivity analyses.ResultsThe base-case results showed that administering low-dose prednisolone at the time of a URTI generated more QALYs and a lower mean cost at 1 year compared with placebo. In the long-term, low-dose prednisolone was associated with a cost saving (£176) and increased effectiveness (0.01 QALYs) compared with placebo and thus remained the dominant treatment option. These findings were robust to all sensitivity analyses.ConclusionA 6-day course of low-dose prednisolone at the time of a URTI in children with steroid-sensitive nephrotic syndrome has the potential to reduce healthcare costs and improve quality of life compared with placebo.

AB - BackgroundChildhood steroid-sensitive nephrotic syndrome is a frequently relapsing disease with significant short- and long-term complications, leading to high healthcare costs and reduced quality of life for patients. The majority of relapses are triggered by upper respiratory tract infections (URTIs) and evidence shows that daily low-dose prednisolone at the time of infection may reduce the risk of relapse.ObjectiveThe aim of this study was to assess the cost effectiveness of a 6-day course of low-dose prednisolone at the start of a URTI when compared with placebo.MethodsA state-transition Markov model was developed to conduct a cost-utility analysis with the outcome measured in quality-adjusted life-years (QALYs). Resource use and outcome data were derived from the PREDNOS2 trial. The analysis was performed from a UK National Health Service perspective and the results were extrapolated to adulthood. Model parameter and structural uncertainty were assessed using sensitivity analyses.ResultsThe base-case results showed that administering low-dose prednisolone at the time of a URTI generated more QALYs and a lower mean cost at 1 year compared with placebo. In the long-term, low-dose prednisolone was associated with a cost saving (£176) and increased effectiveness (0.01 QALYs) compared with placebo and thus remained the dominant treatment option. These findings were robust to all sensitivity analyses.ConclusionA 6-day course of low-dose prednisolone at the time of a URTI in children with steroid-sensitive nephrotic syndrome has the potential to reduce healthcare costs and improve quality of life compared with placebo.

UR - https://www.springer.com/journal/40273

U2 - 10.1007/s41669-022-00334-6

DO - 10.1007/s41669-022-00334-6

M3 - Article

C2 - 35733076

SN - 1170-7690

VL - 6

SP - 605

EP - 617

JO - PharmacoEconomics

JF - PharmacoEconomics

IS - 4

ER -

PREDNOS Collaborative Group, NIHR Medicines for Children Research Network Nephrology Clinical Studies Group, Afentou N , Frew E , Mehta S , Rowland N et al. Economic evaluation of using daily prednisolone versus placebo at the time of an upper respiratory tract infection for the management of children with steroid-sensitive nephrotic syndrome: a model-based analysis. PharmacoEconomics. 2022 Jul;6(4):605-617. Epub 2022 Jun 22. doi: 10.1007/s41669-022-00334-6