TITLE:
A health economic analysis of combination therapy with infliximab plus elemental diet for moderately to severely active Crohn’s disease
AUTHORS:
Shota Saito, Utako Shimizu, Zhang Nan, Junji Yokoyama, Mayumi Watanabe, Kenshi Terajima, Kohei Akazawa
KEYWORDS:
Cost-Effectiveness; Crohn’s Disease; Elemental Diet; Infliximab; Markov Model
JOURNAL NAME:
Health,
Vol.6 No.1,
January
26,
2014
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.