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

Nafsika Afentou, Emma Frew (), Samir Mehta, Natalie J. Ives, Rebecca L. Woolley, Elizabeth A. Brettell, Adam R. Khan, David V. Milford, Detlef Bockenhauer, Moin A. Saleem, Angela S. Hall, Ania Koziell, Heather Maxwell, Shivaram Hegde, Eric Finlay, Rodney D. Gilbert, Caroline Jones, Karl McKeever, Wendy Cook, Nicholas J. A. Webb and Martin T. Christian
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Nafsika Afentou: University of Birmingham
Samir Mehta: University of Birmingham
Natalie J. Ives: University of Birmingham
Rebecca L. Woolley: University of Birmingham
Elizabeth A. Brettell: University of Birmingham
Adam R. Khan: University of Birmingham
David V. Milford: Birmingham Children’s Hospital
Detlef Bockenhauer: University College London
Moin A. Saleem: University of Bristol
Angela S. Hall: Leicester Children’s Hospital
Ania Koziell: King’s College London
Heather Maxwell: Royal Hospital for Sick Children
Shivaram Hegde: University Hospital of Wales
Eric Finlay: Leeds Children’s Hospital
Rodney D. Gilbert: Southampton Children’s Hospital
Caroline Jones: Alder Hey Children’s Hospital
Karl McKeever: Royal Hospital for Sick Children
Wendy Cook: Nephrotic Syndrome Trust (NeST)
Nicholas J. A. Webb: University of Manchester
Martin T. Christian: Nottingham Children’s Hospital

PharmacoEconomics - Open, 2022, vol. 6, issue 4, No 12, 605-617

Abstract: 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.

Date: 2022
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DOI: 10.1007/s41669-022-00334-6

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