Pharmacoeconomics of ColciGel (R) for the Treatment of Acute Gout Flares

Oral Colchicine was effective in only 38% of patients treated for acute flares. 1 It is associated with poor tolerability due to a high-rate of gastrointestinal effects; typically nausea, vomiting, abdominal cramps and diarrhea. Less common but more significant is a strong potential for drug-drug interactions with oral colchicine as it is metabolized and transported by cytochrome P450-3A4 and P-glycoprotein, two systems used by many other drugs. 2 Fatalities have occurred from these drug-drug interactions with colchicine. 3 4 ColciGel (R) is a new option for treating acute flares of gout. It is a transdermal gel that contains colchicine (colchicinum 4X) and is designed to be applied directly on the sites of a flare. Clinical experience has demonstrated the effectiveness of ColciGel in reducing inflammation and pain associated with acute flares. 5 ColciGel patients report a 50% or greater decrease in pain and inflammation within a few hours and improved pain relief with additional applications. ColciGel application is well tolerated as only non-clinically relevant concentrations of colchicine enter systemic circulation. 6 ColciGel, with direct application on the site of the flare, bypasses the gastrointestinal (GI) tract and has limited absorption into the systemic circulation, two sites of significant tolerability and safety issues common with oral colchicine. In this paper, the pharmacoeconomics associated with treating acute flares with ColciGel and oral colchicine are examined. The drug costs for the two treatments are very similar, however oral colchicine therapy has the potential for large hidden costs associated with poor tolerability, serious adverse events (AEs), drug-drug interactions (DDIs), and treatment-failures. ColciGel, without these hidden costs, should be a much more cost-effective treatment.