Health> Vol.6 No.1, January 2014

A health economic analysis of combination therapy with infliximab plus elemental diet for moderately to severely active Crohn’s disease

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ABSTRACT

Although infliximab (IFX) is effective for inducing and maintaining remission in patients with Crohn’s disease (CD), it is much more expensive than other treatments. The aim of this study is to evaluate the cost-effectiveness of several therapies, including IFX, for moderately to severely active CD. A Markov cohort model was constructed to simulate treatment effectiveness and costs. Transition probabilities, utilities, direct medical costs, and productivity costs were estimated using the results of published research. The primary effectiveness measurement was quality-adjusted life years (QALYs), as estimated by the 15D instrument. Expected effectiveness and total costs were calculated for a 10-year period using a yearly discount rate of 3% for QALYs and costs. Multiple one-way sensitivity analyses were performed by varying parameters that were likely to change QALYs and costs. As compared with nonbiologic therapy, therapy with IFX alone resulted in more QALYs and lower costs for the 10-year period. Combination therapy with IFX and elemental diet yielded an additional 0.252 QALYs at an additional cost of $18,522 as compared with nonbiologic therapy over 10 years. The resulting incremental cost-effectiveness ratio (ICER) of combination therapy vs nonbiologic therapy was $73,500/QALY. Patient body weight was the most important factor for cost-effectiveness. In conclusion it

was revealed that combination therapy with IFX plus elemental diet appears not to be a cost-effective treatment for moderately to severely active CD.

Cite this paper

Saito, S. , Shimizu, U. , Nan, Z. , Yokoyama, J. , Watanabe, M. , Terajima, K. and Akazawa, K. (2014) A health economic analysis of combination therapy with infliximab plus elemental diet for moderately to severely active Crohn’s disease. Health, 6, 107-114. doi: 10.4236/health.2014.61017.

References

[1] [1] Colombel, J.F., Sandborn, W.J., Reinisch, W., Mantzaris, G.J., Kornbluth, A., Rachmilewitz, D., Lichtiger, S., D’Haens, G., Diamond, R.H., Broussard, D.L., Tang, K.L., van der Woude, C.J., Rutgeerts, P. and SONIC Study Group (2010) Infliximab, azathioprine, or combination therapy for Crohn’s disease. New England Journal of Medicine, 362, 1383-1395.
http://dx.doi.org/10.1056/NEJMoa0904492
[2] Lofts Jr., E.V. (2004) Clinical epidemiology of inflammatory bowel disease: Incidence, prevalence, and environmental influences. Gastroenterology, 39, 1504-1507.
http://dx.doi.org/10.1053/j.gastro.2004.01.063
[3] Japan Intractable Diseases Research Foundation (2010) Intractable Diseases Information Center.
http://www.nanbyou.or.jp
[4] Hanauer, S.B., Feagan, B.G., Lichternstein, G.R., Mayer, L.F., Schreiber, S., Colombel J.F., Rachmilewitz, D., Wolf, D.C., Olson, A., Bao, W., Rutgeerts, P. and ACCENT I Study Group (2002) Maintenance infliximab for Crohn’s disease. The ACCENT 1 randomised trial. Lancet, 359, 1541-1549.
http://dx.doi.org/10.1016/S0140-6736(02)08512-4
[5] Tanaka, T., Takahama, K., Kimura, T., Mizuno, T., Nagasaka, M., Iwata, K., Nakano, H., Muramatsu, M. and Takazoe, M. (2006) Effect of concurrent elemental diet on infliximab treatment for Crohn’s disease. Journal of Gastroenterology and Hepatology, 21, 1143-1149.
http://dx.doi.org/10.1111/j.1440-1746.2006.04317.x
[6] Yamamoto, T., Nakahigashi, M., Umegae, S. and Matsumoto, K. (2010) Prospective clinical trial: Enteral nutrition during maintenance infliximab in Crohn’s disease. Journal of Gastroenterology, 45, 24-29.
http://dx.doi.org/10.1007/s00535-009-0136-5
[7] Yu, A.P., Cabanilla, L.A. and Wu, E.Q. (2008) The costs of Crohn’s disease in the United States and other Western countries: A systematic review. Current Medical Research and Opinion, 24, 319-328.
http://dx.doi.org/10.1185/030079908X260790
[8] Lichtiger, S., Binion, D.G., Wolf, D.C., Present, D.H., Bensimon, A.G., Wu, E., Yu, A.P., Cardoso, A.T., Chao, J., Mulani, P.M., Lomax, K.G. and Kent, J.D. (2010) The CHOICE trial: Adalimumab demonstrates safety, fistula healing, improved quality of life and increased work productivity in patients with Crohn’s disease who failed prior infliximab therapy. Alimentary Pharmacology & Therapeutics, 32, 1228-1239.
http://dx.doi.org/10.1111/j.1365-2036.2010.04466.x
[9] Munkholm, P., Langholz, E., Davidsen, M. and Binder, V. (1995) Disease activity courses in a regional cohort of Crohn’s disease patients. Scandinavian Journal of Gastroenterology, 30, 699-706.
http://dx.doi.org/10.3109/00365529509096316
[10] Jaisson-Hot, I., Flourié, B., Descos, L. and Colin, C. (2004) Management for severe Crohn’s disease: A life-time costutility analysis. International Journal of Technology Assessment in Health Care, 20, 274-279.
http://dx.doi.org/10.1017/S0266462304001084
[11] Kaplan, G.G., Hur, C., Korzenik. J. and Sands, B.E. (2007) Infliximab dose escalation VS. initiation of adalimumab for loss of response in Crohn’s disease: A cost-effectiveness analysis. Alimentary Pharmacology & Therapeutics, 26, 1509-1520.
http://dx.doi.org/10.1111/j.1365-2036.2007.03548.x
[12] Lindsay, J., Punekar, Y.S., Morris, J. and Chung-Faye, G. (2008) Health-economic analysis: Cost-effectiveness of scheduled maintenance treatment with infliximab for Crohn’s disease—Modeling outcomes in active luminal and fistulizing disease in adults. Alimentary Pharmacology & Therapeutics, 28, 76-87.
http://dx.doi.org/10.1111/j.1365-2036.2008.03709.x
[13] Bodger, K., Kikuchi, T. and Hughes, D. (2009) Cost-effectiveness of biological therapy for Crohn’s disease: Markov cohort analyses incorporating United Kingdom patient-level cost data. Alimentary Pharmacology & Therapeutics, 30, 265-274.
http://dx.doi.org/10.1111/j.1365-2036.2009.04033.x
[14] Punekar, Y.S., Sunderland, T., Hawkins. N. and Lindsay, J. (2010) Cost-effectiveness of Scheduled Maintenance Treatment with Infliximab for Pediatric Crohn’s Disease. Value Health, 13, 188-195.
http://dx.doi.org/10.1111/j.1524-4733.2009.00658.x
[15] Nakamura, J., Toyabe, S.I., Aoyagi, Y. and Akazawa, K. (2008) Economic impact of extended treat-ment with peginterferon α-2a and ribavirin for slow hepatitis C virologic responder. Journal of Viral Hepatitis, 15, 293-299.
http://dx.doi.org/10.1111/j.1365-2893.2007.00943.x
[16] Takagi, S., Utsunomiya, K., Kuriyama, S., Yokoyama, H., Takahashi, S., Iwabuchi, M., Takahashi, H., Takahashi, S., Kinouchi, Y., Hiwatashi, N., Funayama, Y., Sasaki, I., Tsuji, I. and Shimosegawa, T. (2006) Effectiveness of an “half elemental diet” as maintenance therapy for Crohn’s disease: A randomized—Controlled trial. Alimentary Pharmacology & Therapeutics, 24, 1333-1340.
http://dx.doi.org/10.1111/j.1365-2036.2006.03120.x
[17] Jess, T., Loftus, E.V., Harmsen, W.S., Zinsmeister A.R., Tremaine, W.J., Melton III, L.J., Munkholm, P. and Sandborn, W.J. (2006) Survival and cause specific mortality in patients with inflammatory bowel disease: A long term outcome study in Olmsted Country, Minnesota, 1940-2004. Gut, 4, 621-630.
[18] Lichtenstein, G.R., Feagan, B.G., Cohen, R.D., Salzberg, B.A., Diamond, R.H., Chen, D.M., Pritchard, M.L. and Sandborn W.J. (2006) Serious infections and mortality in association with therapies for Crohn’s Disease: TREAT registry. Clinical Gastroenterology and Hepatology, 4, 621-630. http://dx.doi.org/10.1016/j.cgh.2006.03.002
[19] Matsumoto, T., Iida. M., Motoya, S., Haruma, K., Suzuki, Y., Kobayashi, K., Ito, H., Miyata M., Kusunoki, M., Chiba, T., Yamamoto, S. and Hibi, T. (2008) Therapeutic efficacy of infliximab on patients with short duration of Crohn’s disease: A Japanese multicenter survey. Diseases of the Colon & Rectum, 51, 916-923.
http://dx.doi.org/10.1007/s10350-008-9241-4
[20] Siegel, C.A., Hur, C., Korzenik, J.R. and Sands, B.E. (2006) Risk and benefits of infliximab for the treatment of Crohn’s disease. Clinical Gastroenterology and Hepatology, 4, 1017-1024.
http://dx.doi.org/10.1016/j.cgh.2006.05.020
[21] Tokyo Stastics and Information Department, Minister’s Secretariat, Ministry of Health, Labour, and Welfare (2010) Abridged life Table for Japan, 2008.
http://www.mhlw.go.jp/toukei/saikin/hw/life/life08/index.html
[22] Odes, S., Vardi, H., Friger, M., Esser, D., Wolters, F., Moum, B., Waters, H., Elkjaer, M., Bernklev, T., Tsianos, E., O’Morain, C., Stockbrügger, R., Munkholm, P. and Langholz, E. (2010) Clinical and economic outcomes in a population-based European cohort of 948 ulcerative colitis and Crohn’s disease patients by Markov analysis. Alimentary Pharmacology & Therapeutics, 31, 735-744.
http://dx.doi.org/10.1111/j.1365-2036.2009.04228.x
[23] Mesterton, J., J?nsson, L., Almer, S.H., Befrits, R., Friis-Liby, I. and Lindgren, S. (2009) Resource use and societal costs for Crohn’s disease in Sweden. Inflammatory Bowel Diseases, 15, 1882-1890.
http://dx.doi.org/10.1002/ibd.20939
[24] Organization for Economic Co-Operation and Development (2008) OECD economic outlook No. 87 annex tables—Table of contents 2008.
http://www.oecd.org/eco/outlook/economicoutlookannextables.htm
[25] Yu, A.P., Johnson, S., Wang, S.T., Atanasov, P., Tang, J., Wu, E., Chao, J. and Mulani, P.M. (2009) Cost utility of adalimumab versus infliximab maintenance therapies in the United States for moderately to severely active Crohn’s disease. Pharmacoeconomics, 27, 609-621.
http://dx.doi.org/10.2165/11312710-000000000-00000
[26] Ministry of Health, Labour and Welfare (2010) Various Information of Medical Fee.
http://www.iryohoken.go.jp/shinryohoshu/
[27] Weinsteins, M.C., Siegel, J.E., Gold, M.R., Kamlet, M.S. and Russell, L.B. (1996) Recommendations of the panel on cost-effectiveness in health and medicine. JAMA, 276, 1253-1258.
http://dx.doi.org/10.1001/jama.1996.03540150055031
[28] Verma, S., Kirkwood, B., Brown, S., Brown, S. and Giaffer, M.H. (2000) Oral nutritional supplementation is effective in the maintenance of remission in Crohn’s disease. Digestive and Liver Disease, 32, 769-774.
http://dx.doi.org/10.1016/S1590-8658(00)80353-9
[29] Yamamoto, T., Nakahigashi, M., Umedae, S., Kitagawa, T. and Matsumotom K. (2007) Impact of long-term enteral nutrition on clinical and endoscopic recurrence after resection for Crohn’s disease: A prospective, non-randomised, parallel, controlled study. Alimentary Pharmacology & Therapeutics, 25, 67-72.
http://dx.doi.org/10.1111/j.1365-2036.2006.03158.x
[30] Schreiber, S, Khaliq-Kareemi, M., Lawrance, I.C., Thomsen, O.?. and Hanauer, S.B., McColm, J., Bloomfield, R., Sandborn, W.J., PRECISE 2 study investigators (2007) Maintenance therapy with certlizumab pegol for Crohn’s disease. New England Journal of Medicine, 357, 239-250.
http://dx.doi.org/10.1056/NEJMoa062897
[31] Kopylov, U., Mantzaris, G.J., Katsanos, K.H., Reenaers, C., Ellul, P., Rahier, J.F., Israeli, E., Lakatos, P.L., Fiorino, G., Cesarini, M., Tsianos, E.V., Louis, E. and Ben-Horin, S. (2011) The efficacy of shortening the dosing interval to once every six weeks in Crohn’s patients losing response to maintenance dose of infliximab. Alimentary Pharmacology & Therapeutics, 33, 349-357.
http://dx.doi.org/10.1111/j.1365-2036.2010.04523.x

  
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