Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Does Asymptomatic Hyperuricemia Treatment Improve Health? A Decision-Analytic Evaluation.

Akkineni2,  Roopa, Lee2,  Alexandra, Miller2,  Katherine, Tosteson2,  Anna, Albert1,  Daniel A.

Dartmouth-Hitchcock Med Ctr, Lebanon, NH
The Dartmouth Institute

Purpose:

Recent studies have suggested that elevated uric acid levels are associated with an increase in coronary and cerebrovascular disease. Treatment for asymptomatic hyperuricemia with uric acid lowering drugs, such as Allopurinol, may reduce cardiovascular events. However, some patients have experienced adverse drug reactions while treated with Allopurinol. A decision analysis was designed to identify the optimal treatment strategy for patients with asymptomatic hyperuricemia.

Methods:

A Markov state-transition model was constructed to assess the occurrence of cardiovascular events and life expectancy in patients undergoing urate-lowering treatment with Allopurinol, compared with watchful waiting. The model was built for a hypothetical 50-year old asymptomatic hyperuricemic male patient. Probabilities were derived from current literature. Developments of gout or uric acid stones as well as cardiovascular events were modeled. Sensitivity analyses were conducted for drug effectiveness and probability of adverse drug reaction.

Results:

In the base–case analysis, the two treatment options had a similar occurrence of vascular events and life expectancy. However, watchful waiting was associated with a slightly greater gain in quality adjusted life years (QALYs) than treatment with Allopurinol (10.61 QALYs versus 10.58 QALYs). A sensitivity analysis was conducted on drug effectiveness, drug protection from cardiovascular events, the probability of adverse drug event, and death from adverse drug reaction. When the probability of having an adverse drug reaction increased, watchful waiting was always favored. The results were similar for probability of death from adverse drug reaction. By contrast, when the effectiveness of drug therapy varied, treatment with Allopurinol was the optimal choice for effectiveness rates over 69.2%. The maximum gain in QALYs assuming 100% effectiveness of Allopurinol therapy was approximately 0.35 QALYs.

Conclusions:

Watchful waiting was preferred for patients with asymptomatic hyperuricemia at the base rate of 21% effectiveness of Allopurinol; however, the number of QALYs gained with watchful waiting was small compared to treatment with Allopurinol. At 100% effectiveness, treatment with Allopurinol was the preferred strategy with a gain of 0.35 QALYs, which in magnitude is similar to statin therapy with 0.25 QALYs gained.

To cite this abstract, please use the following information:
Akkineni, Roopa, Lee, Alexandra, Miller, Katherine, Tosteson, Anna, Albert, Daniel A.; Does Asymptomatic Hyperuricemia Treatment Improve Health? A Decision-Analytic Evaluation. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :992
DOI: 10.1002/art.28759

Abstract Supplement

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