Cost-Effectiveness of Lubiprostone in a Managed Care Population with Chronic Idiopathic Constipation

Purpose: Treatment of chronic idiopathic constipation (CIC) can be costly. Recently, medications used to treat CIC over longer time periods have been approved and have been consistently reimbursed. Understanding the economic consequences of these treatments as currently prescribed in managed care health plans is important to decision-makers. To assess cost effectiveness of treating patients with lubiprostone from a United States (US) healthcare payer perspective. Methods: We developed a Markov model to compare treatment with lubiprostone to tegaserod in adult patients with history of CIC (per Rome II Guidelines). Perspective of the third party payor was modeled. Age and gender distributions of CIC patients were taken from an analysis of managed care claims data. Treatment patterns were applied as observed in managed care claims data which included treatment with tegaserod in patients over 65 years of age. Treatment efficacy data, rescue medication use, and symptoms scores were extracted from FDA Approved Clinical Trials and product labels. Direct cost data were drawn from standard US costing sources (WAC prices) and published analyses of claims data. The model was projected over a one-year time horizon. Results: Among CIC patients prescribed lubiprostone or tegaserod within a managed care health plan, those treated with lubiprostone had lower drug costs ($1,547 versus $1,746) and fewer medical costs ($2,330 versus $2,486) than patients on tegaserod. Patients on lubiprostone had more symptom-free days than patients on tegaserod (326 versus 301, respectively). Fewer lubiprostone-treated patients required rescue medications than those on tegaserod (35.3% versus 47.1%, respectively). As a result, treating with lubiprostone was dominant compared to tegaserod. In probabilistic sensitivity analyses, 91.4% of 1000 simulations demonstrated dominant results. Conclusion: Based on analyses of managed care treatment patterns, lubiprostone is less costly and more effective than tegaserod for treatment of CIC. Cost-effective options for reimbursement remain available.