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Weight Reduction and Pioglitazone are Cost-Effective for the Treatment of Non-Alcoholic Fatty Liver Disease in Thailand

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Abstract

Introduction

This study evaluated lifetime liver-related clinical outcomes, costs of treatment, and the cost-effectiveness of treatment options for non-alcoholic fatty liver disease (NAFLD) in Thailand.

Methods

A cost-utility analysis using a lifetime Markov model was conducted among Thai patients with NAFLD, from a societal perspective. Pioglitazone, vitamin E, a weight reduction program, and usual care were investigated, with the outcomes of interest being the number of cirrhosis and hepatocellular carcinoma (HCC) cases, life expectancy, quality-adjusted life-years (QALYs), lifetime costs, and the incremental cost-effectiveness ratios (ICERs). One-way and probabilistic sensitivity analyses were performed.

Results

When compared with usual care, a weight reduction program can prevent cirrhosis and HCC cases by 13.91% (95% credible interval [CrI] 0.97, 20.59) and 2.12% (95% CrI 0.43, 4.56), respectively; pioglitazone can prevent cirrhosis and HCC cases by 9.30% (95% CrI −2.52, 15.24) and 1.42% (95% CrI −0.18, 3.74), respectively; and vitamin E can prevent cirrhosis and HCC cases by 7.32% (95% CrI −4.64, 15.56) and 1.12% (95% CrI −0.81, 3.44), respectively. Estimated incremental life expectancy and incremental QALYs for all treatment options compared with usual care were approximately 0.06 years and 0.07 QALYs, respectively. The lifetime costs of both a weight reduction program and pioglitazone were less than usual care, while vitamin E was $3050 (95% CrI 2354, 3650). The weight reduction program dominated all other treatment options. The probability of being cost-effective in Thailand’s willingness-to-pay threshold ($4546/QALY gained) was 76% for the weight reduction program, 22% for pioglitazone, 2% for usual care, and 0% for vitamin E.

Conclusions

A weight reduction program can prevent cirrhosis and HCC occurrences, and dominates all other treatment options. Pioglitazone and vitamin E demonstrated a trend towards decreasing the number of cirrhosis and HCC cases.

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Acknowledgments

The authors wish to thank Peter Barton from the writing clinic at Naresuan University Language Center for editing this work.

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Authors and Affiliations

  1. Center of Pharmaceutical Outcomes Research, Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Naresuan University, 65000, Phitsanulok, Thailand

    Bunchai Chongmelaxme, Piyameth Dilokthornsakul & Nathorn Chaiyakunapruk

  2. Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

    Pochamana Phisalprapa

  3. Clinical Pharmacy Research Unit, Department of Clinical Pharmacy, Faculty of Pharmacy, Mahasarakham University, Mahasarakham, Thailand

    Ratree Sawangjit

  4. School of Pharmacy, Monash University Malaysia, Selangor, Malaysia

    Ratree Sawangjit & Nathorn Chaiyakunapruk

  5. School of Pharmacy, University of Wisconsin, Wisconsin, MA, USA

    Nathorn Chaiyakunapruk

  6. Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-Being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia

    Nathorn Chaiyakunapruk

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  1. Bunchai Chongmelaxme
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Contributions

BC and PP participated in the study concept and design, data acquisition, data analysis, data interpretation, manuscript drafting, and critical revision and final review of the manuscript. RS, PD and NC participated in the study concept and design, data interpretation, manuscript drafting, and critical revision and final review of the manuscript.

Corresponding authors

Correspondence to Piyameth Dilokthornsakul or Nathorn Chaiyakunapruk.

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Bunchai Chongmelaxme, Pochamana Phisalprapa, Ratree Sawangjit, Piyameth Dilokthornsakul, and Nathorn Chaiyakunapruk declare no potential conflicts of interest with respect to the research, organization, and publication of this work.

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The authors received no specific funding for this work.

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Chongmelaxme, B., Phisalprapa, P., Sawangjit, R. et al. Weight Reduction and Pioglitazone are Cost-Effective for the Treatment of Non-Alcoholic Fatty Liver Disease in Thailand. PharmacoEconomics 37, 267–278 (2019). https://doi.org/10.1007/s40273-018-0736-0

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