Cost and health consequences of treatment of primary biliary cirrhosis with ursodeoxycholic acid in a Norwegian patient population
Bibliographic record
Abstract
Background/aims: Primary biliary cirrhosis (PBC) is a chronic, cholestatic liver disease that progresses to liver cirrhosis. Patients who develop end-stage liver disease are candidates for\nliver transplantation. Several studies have supported the view that ursodeoxycholic acid (UDCA) prolongs survival in PBC, but results have been challenged in other reports. Nevertheless, UDCA is currently recommended as standard therapy in PBC. The aims of this\nstudy were to 1) evaluate the effect of UDCA on the clinical course in a Norwegian cohort of PBC patients and to 2) estimate cost-effectiveness of UDCA therapy in the perspective of\npublic health service.\nPatients and methods: 180 Norwegian PBC patients (90% females; mean age 56.2 ± 8.9 years; Mayo risk score 4.38) were included in a five-year open-label study of UDCA therapy. The observed survival of the UDCA-treated patients was compared with survival predicted from the Mayo prognostic model for PBC and with survival (at four years) of the placebo group in a previous Canadian trial of UDCA in PBC (n = 111; 95% females; mean age 55.4 years; Mayo risk score 4.4). The frequencies of major events in the UDCA group were compared with those of the combined placebo groups in the Canadian trial and a previous study from the Mayo Clinic (n = 91; 87% females; Mayo risk score 5.2). The hospital costing model for Rikshospitalet University Hospital was applied to estimate average annual costs (2005 NOK) of major events. A spread sheet model was constructed for the calculations of costs. Cost-effectiveness was expressed as the ratio of incremental cost of UDCA therapy as compared with standard therapy, to the incremental gain in life expectancy during the four\nyears of study.\nResults: The observed survival of the UDCA-treated patients was significantly higher than that of the control group (P < 0.001; log-rank test). Within the four-year perspective, the life expectancy was 3.92 years in patients on UDCA therapy and 3.54 years in those receiving standard treatment (discounted, 3.57 years and 3.22 years, respectively). The life expectancey of the UDCA-treated patients according to the Mayo prognostic model was 3.79 years (discounted 3.45 years). The net total discounted cost per patient of the UDCA strategy was NOK 73 000 as compared with NOK 302 000 of standard treatment. Thus, the incremental discounted cost of UDCA therapy as compared with standard therapy was minus NOK 229 000, and the incremental discounted gain in life expectancy was 0.35 years. One-way\nsensitivity analysis revealed that even the upper bound cost estimate in the UDCA group (NOK 205 000) was slightly less that the lower bound estimate in the control group (NOK 210 000).\nConclusions: The results of this study indicate that UDCA therapy in PBC confers reduced morbidity, gain in life expectancy as well as cost savings comparedwith standard therapy and thus represents a dominant strategy.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".