Cost‐Effectiveness of Low‐Dose Colchicine Prophylaxis When Starting Allopurinol Using the “Start‐Low Go‐Slow” Approach for Gout: Evidence From a Noninferiority Randomized Double‐Blind Placebo‐Controlled Trial
Authors' conclusion
Six months of low-dose colchicine prophylaxis when starting allopurinol using the "start-low go-slow" approach is unlikely to be cost-effective over 12 months.
Study context
- Population
- Participants with gout fulfilling ACR recommendations for starting ULT, serum urate ≥0.36 mmol/L (6 mg/dL)
- Participants
- 200 participants
- Comparison
- Colchicine 0.5 mg daily vs placebo for 6 months when starting allopurinol (start-low go-slow)
- Colchicinen = 100
- Placebon = 100reference
- Primary endpoint
- Incremental cost-effectiveness from the health system perspective, measured by incremental net monetary benefit (INMB) at a willingness-to-pay threshold equivalent to GDP per capita
- Follow-up
- 6 months and 1 year
Methodological detailsnon-inferiority, double-blind, placebo-controlled, health system perspective
- Non-inferiority
- Double-blind
- Placebo-controlled
- Health system perspective
Primary result
As reported in the abstract
INMB (health system perspective) · 6 months and 12 months
Incremental net monetary benefit (INMB)
-$1,373
95% CI -$4,287 to $1,542
6 months; probability of cost-effectiveness 17.7%
INMB
-$3,191
95% CI -$6,274 to -$107
12 months; probability of cost-effectiveness 1.5%
Further findings
| Outcome | Adjusted mean difference (95% CI) | |
|---|---|---|
| Quality-adjusted life years · 6 months and 1 yearColchicinevs PlaceboSix months | 0.008 (−0.020 to 0.035) | |
| Quality-adjusted life years · 6 months and 1 yearColchicinevs PlaceboOne year | −0.015 (−0.039 to 0.010) | |
| −0.04−0.0200.020.04Difference (linear scale) |
| Outcome | Adjusted mean difference (95% CI) |
|---|---|
| Mean costs · 6 months and 1 yearColchicine vs Placebo · six months | $1,848 (-$321 to $4,017) |
| Mean costs · 6 months and 1 yearColchicine vs Placebo · one year | $2,282 (-$173 to $4,737) |
Cost-effectiveness, societal perspective
- Similar results were obtained from a societal perspective
Original publication
Cost‐Effectiveness of Low‐Dose Colchicine Prophylaxis When Starting Allopurinol Using the “Start‐Low Go‐Slow” Approach for Gout: Evidence From a Noninferiority Randomized Double‐Blind Placebo‐Controlled Trial. Arthritis Care Res (Hoboken). Published 25 November 2025. doi:10.
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