Comparative Effectiveness Review Number 176 Management of Gout Comparative Effectiveness Review Number 176 Management of Gout Prepared for: Agency for Healthcare Research and Quality U.S. Department of Health and Human Services 5600 Fishers Lane Rockville, MD 20857 www.ahrq.gov Contract No. 290-2012-00006-I Prepared by: RAND Southern California Evidence-Based Practice Center Santa Monica, CA Investigators: Paul G. Shekelle, M.D, Ph.D. John FitzGerald, M.D., Ph.D. Sydne J. Newberry, Ph.D. Aneesa Motala, B.A. Claire E. O’Hanlon, M.P.P. Adeyemi Okunogbe, M.D. Abdul Tariq, B.S. Dan Han, M.P.A. Whitney Dudley, B.S. Roberta Shanman, M.L.S. Marika Booth, M.S. AHRQ Publication No. 16-EHC017-EF March 2016 Addendum October 2016 Addendum – October 2016 In the manuscript summarizing the findings of this report for journal submission, we performed an update search to March 2016. We identified 11 new publications meeting inclusion criteria. Incorporating these new studies did not change any conclusion or strength of evidence for any conclusion. More information is located in the Annals of Internal Medicine manuscript: http://annals.org/aim/article/doi/10.7326/M16-0461. This report is based on research conducted by the RAND Southern California Evidence-based Practice Center (SCEPC) under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-2012-00006-I). The findings and conclusions in this document are those of the authors, who are responsible for its contents; the findings and conclusions do not necessarily represent the views of AHRQ. Therefore, no statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. None of the investigators has any affiliations or financial involvement related to the material presented in this report. The information in this report is intended to help health care decisionmakers—patients and clinicians, health system leaders, and policymakers, among others—make well informed decisions and thereby improve the quality of health care services. This report is not intended to be a substitute for the application of clinical judgment. Anyone who makes decisions concerning the provision of clinical care should consider this report in the same way as any medical reference and in conjunction with all other pertinent information, i.e., in the context of available resources and circumstances presented by individual patients. This report is made available to the public under the terms of a licensing agreement between the author and the Agency for Healthcare Research and Quality. This report may be used and reprinted without permission except those copyrighted materials that are clearly noted in the report. Further reproduction of those copyrighted materials is prohibited without the express permission of copyright holders. AHRQ or U.S. Department of Health and Human Services endorsement of any derivative products that may be developed from this report, such as clinical practice guidelines, other quality enhancement tools, or reimbursement or coverage policies may not be stated or implied. This report may periodically be assessed for currency of conclusions. If an assessment is done, the resulting surveillance report describing the methodology and findings will be found on the Effective Health Care Program Web site at www.effectivehealthcare.ahrq.gov. Search on the title of the report. Persons using assistive technology may not be able to fully access information in this report. For assistance contact [email protected]. Suggested citation: Shekelle PG, FitzGerald J, Newberry SJ, Motala A, O’Hanlon CE, Okunogbe A, Tariq A, Han D, Dudley W, Shanman R, Booth M. Management of Gout. Comparative Effectiveness Review No. 176. (Prepared by the RAND Southern California Evidence-based Practice Center under Contract No. 290-2012-00006-I.) AHRQ Publication No.16-EHC017-EF. Rockville, MD: Agency for Healthcare Research and Quality; March 2016. Addendum October 2016. www.effectivehealthcare.ahrq.gov/reports/final.cfm. ii Preface The Agency for Healthcare Research and Quality (AHRQ), through its Evidence-based Practice Centers (EPCs), sponsors the development of systematic reviews to assist public- and private-sector organizations in their efforts to improve the quality of health care in the United States. These reviews provide comprehensive, science-based information on common, costly medical conditions, and new health care technologies and strategies. Systematic reviews are the building blocks underlying evidence-based practice; they focus attention on the strength and limits of evidence from research studies about the effectiveness and safety of a clinical intervention. In the context of developing recommendations for practice, systematic reviews can help clarify whether assertions about the value of the intervention are based on strong evidence from clinical studies. For more information about AHRQ EPC systematic reviews, see www.effectivehealthcare.ahrq.gov/reference/purpose.cfm AHRQ expects that these systematic reviews will be helpful to health plans, providers, purchasers, government programs, and the health care system as a whole. Transparency and stakeholder input are essential to the Effective Health Care Program. Please visit the Web site (www.effectivehealthcare.ahrq.gov) to see draft research questions and reports or to join an e- mail list to learn about new program products and opportunities for input. We welcome comments on this systematic review. They may be sent by mail to the Task Order Officer named below at: Agency for Healthcare Research and Quality, 5600 Fishers Lane, Rockville, MD 20857, or by email to [email protected]. Richard G. Kronick, Ph.D. Arlene S. Bierman, M.D., M.S. Director Director Agency for Healthcare Research and Quality Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality Stephanie Chang M.D., M.P.H. Aysegul Gozu, M.D., M.P.H Director, EPC Program Task Order Officer Center for Evidence and Practice Improvement Center for Evidence and Practice Improvement Agency for Healthcare Research and Quality Agency for Healthcare Research and Quality iii Acknowledgments The authors gratefully acknowledge Patricia Smith for her administrative support on the project. Key Informants In designing the study questions, the EPC consulted several Key Informants who represent the end-users of research. The EPC sought the Key Informant input on the priority areas for research and synthesis. Key Informants are not involved in the analysis of the evidence or the writing of the report. Therefore, in the end, study questions, design, methodological approaches, and/or conclusions do not necessarily represent the views of individual Key Informants. Key Informants must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their role as end-users, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any conflicts of interest. The list of Key Informants who participated in developing this report follows: Hyon K. Choi, M.D., Ph.D. Gerald D. Levy, M.D. Professor of Medicine, Harvard Medical Rheumatologist School Southern California Permanent Medical Director, Gout and Crystal Arthropathy Group Center Downey, CA Director, Clinical Epidemiology and Health Outcomes Shari Ling, M.D. Division of Rheumatology, Allergy, Deputy Chief Medical Officer and Immunology Office of Clinical Standards and Quality Department of Medicine Centers for Medicare & Medicaid Services Massachusetts General Hospital Baltimore, MD Boston, MA Ted R. Mikuls, M.D., M.S.P.H Russell Harris, M.D., M.P.H. Umbach Professor of Rheumatology Sheps Center for Health Services Research Division of Rheumatology University of North Carolina Department of Internal Medicine Professor, Division of General Medicine University of Nebraska Medical Center University of North Carolina–Chapel Hill and VA Nebraska-Western Iowa Health Chapel Hill, NC Care System Omaha, NE David Hoelting, M.D. Pender Community Hospital Richard Treger, M.D. Pender, NE Board-Certified Nephrologist Greater Los Angeles VA Health Care Sanford S. Kaplan, D.D.S. System Patient Advocate Los Angeles, CA Los Angeles, CA iv Lee Ann Weintraub, M.S., R.D. Neil Wenger, M.D. Dietitian General Internist Private Practice General Internal Medicine Physician Los Angeles, CA and Senior Researcher RAND and University of California, Los Angeles Los Angeles, CA Technical Expert Panel In designing the study questions and methodology at the outset of this report, the EPC consulted several technical and content experts. Broad expertise and perspectives were sought. Divergent and conflicted opinions are common and perceived as healthy scientific discourse that results in a thoughtful, relevant systematic review. Therefore, in the end, study questions, design, methodologic approaches, and/or conclusions do not necessarily represent the views of individual technical and content experts. Technical Experts must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. The list of Technical Experts who participated in developing