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 v2207
(95% CI: v1402 to v3332) and v2945 (95% CI: v1717
to v4592), respectively. The annual average cost-saving
of adding topical mesalazine delivered for four weeks
during active UC was v738. The average annual costs of
maintenance of remission with OD and BID therapy were
v1293 (95% CI: v1062 to v1496) and v1502 (95% CI: v1262 to 1708), respectively with an annual average per person savings of v209. 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.