A two-stage decision analysis to assess the cost of 5-aminosalicylic acid failure and the economics of balsalazide versus mesalamine in the treatment of ulcerative colitis.

Ulcerative colitis (UC) is a costly disease, especially if not properly treated. Epidemiologic studies have shown that many patients progress in one year from initial treatment with prednisone to expensive colonectomy surgery if the UC is not managed with drug therapy. A two-stage decision analysis was conducted to (1) estimate the cost of a 5-aminosalicylic acid (5-ASA) treatment failure using the treatment guidelines recommended by the American College of Gastroenterology and (2) incorporate the cost of a 5-ASA treatment failure to determine which oral 5-ASA agent results in cost minimization and cost effectiveness. The analysis was conducted from the payer perspective, incorporating results from clinical trials directly comparing oral balsalazide capsules and a specific formulation of oral mesalamine. Health care costs related to UC for an oral 5-ASA failure is greater than dollar 11,500 on average in the first six months after therapy. Patients treated with balsalazide capsules had 16% lower total direct health care costs, 32% better outcomes (days without symptoms or steroids), and 37% greater cost effectiveness compared with patients treated with a specific formulation of oral mesalamine. Coordinated efforts should be taken to avoid the cost and morbidity associated with 5-ASA treatment failures.