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Br J Dermatol. 2017 Dec;177(6):1527-1536. doi: 10.1111/bjd.15561. Epub 2017 May 31.

Ciclosporin compared with prednisolone therapy for patients with pyoderma gangrenosum: cost-effectiveness analysis of the STOP GAP trial.

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Warwick Medical School, University of Warwick, Coventry, CV4 7AL, U.K.
Centre of Evidence Based Dermatology, University of Nottingham, NG7 2NR, U.K.
Division of Applied Medicine, Aberdeen University, Aberdeen, AB24 2ZD, U.K.
Department of Dermatology, NHS Forth Valley, Stirling, FK8 2AU, U.K.
Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, NG7 2UH, U.K.
Edinburgh Clinical Trials Unit, Usher Institute, University of Edinburgh, EH16 4TU, U.K.



Pyoderma gangrenosum (PG) is a painful, ulcerating skin disease with poor evidence for management. Prednisolone and ciclosporin are the most commonly used treatments, although not previously compared within a randomized controlled trial (RCT).


To compare the cost-effectiveness of ciclosporin and prednisolone-initiated treatment for patients with PG.


Quality of life (QoL, EuroQoL five dimensions three level questionnaire, EQ-5D-3L) and resource data were collected as part of the STOP GAP trial: a multicentre, parallel-group, observer-blind RCT. Within-trial analysis used bivariate regression of costs and quality-adjusted life years (QALYs), with multiple imputation of missing data, informing a probabilistic assessment of incremental treatment cost-effectiveness from a health service perspective.


In the base case analysis, when compared with prednisolone, ciclosporin was cost-effective due to a reduction in costs [net cost: -£1160; 95% confidence interval (CI) -2991 to 672] and improvement in QoL (net QALYs: 0·055; 95% CI 0·018-0·093). However, this finding appears driven by a minority of patients with large lesions (≥ 20 cm2 ) (net cost: -£5310; 95% CI -9729 to -891; net QALYs: 0·077; 95% CI 0·004-0·151). The incremental cost-effectiveness of ciclosporin for the majority of patients with smaller lesions was £23 374/QALY, although the estimate is imprecise: the probability of being cost-effective at a willingness-to-pay of £20 000/QALY was 43%.


Consistent with the clinical findings of the STOP GAP trial, patients with small lesions should receive treatment guided by the side-effect profiles of the drugs and patient preference - neither strategy is clearly a preferred use of National Health Service resources. However, ciclosporin-initiated treatment may be more cost-effective for patients with large lesions.

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