OBJECTIVES: Febuxostat is recommended as a second-line treatment for gout patients who failed on allopurinol treatment. We aim to analyze the cost-effectiveness of febuxostat as a second-line option in the Algerian setting.

METHODS: A decision tree followed by a Markov model was constructed. The model reflects the serum uric acid (sUA) -defined health states, treatment pathways, acute flare events, and per-cycle transitions. The time horizon of the model is 5 years. A hypothetical cohort of 1000 patients was assumed to be on one of three treatment sequences: 1) patients on allopurinol 100/300 mg, then no treatment if failed; 2) patients on allopurinol 100/300 mg then febuxostat 80 mg if failed; 3) patients on allopurinol 100/300 mg then febuxostat 80 mg if failed, then febuxostat 120 mg if failed. Clinical data were extracted from randomized controlled trials, and cost data was collected through surveys. Probabilistic sensitivity analysis (PSA) was conducted as a confirmatory analysis. The costs are presented in the 2024 Algerian Dinar (DZD).

RESULTS: Sequence 3 was associated with higher gains in clinical and cost outcomes compared to sequence 1 at an incremental cost-effectiveness ratio (ICER) of DZD393 per one additional patient achieving sUA≤6 mg/dl; compared to sequence 2 at an incremental cost-effectiveness ratio (ICER) of DZD747 per one additional patient achieving sUA≤6 mg/dl. Univariate sensitivity analysis demonstrated that the results were robust to changes in input parameters. The model was most sensitive to changes in the cost of febuxostat 120mg.

CONCLUSIONS: In Algeria, Febuxostat 120/80 mg as a second-line treatment after allopurinol 100/300mg in gout patients is associated with improved clinical and reasonable economic outcomes compared to allopurinol 100/300mg only.