The cost-effectiveness of biological therapy cycles in the management of Crohn’s disease.
J Crohns Colitis. 2019 Mar 20;:
Authors: Bolin K, Hertervig E, Louis E
OBJECTIVES: to examine the cost-effectiveness of continued treatment for patients with moderate-severe Crohn’s disease in clinical remission, with a combination of anti-TNFα (infliximab) and immunomodulator therapy compared to two different withdrawal strategies (1) withdrawal of the anti-TNFα therapy, and (2) withdrawal of the immunomodulator therapy, respectively.
MATERIAL AND METHODS: A decision-tree model was constructed mimicking three treatment arms: (1) continued combination therapy with infliximab and immunomodulator, (2) withdrawal of infliximab, or (3) withdrawal of the immunomodulator. Relapses in each arm are managed with treatment intensification and reinstitution of the de-escalated drug according to a prespecified algorithm. State dependent relapse risks, remission probabilities and quality of life weights were collected from previous published studies.
RESULTS: Combination therapy was less costly and more efficient than the withdrawal of the immunomodulator, and more costly and more efficient than withdrawal of infliximab. Whether or not combination therapy is cost effective, compared to the alternatives, depends, primarily, on current pharmaceutical prices and the willingness to pay per additional QALY.
CONCLUSIONS: Combination therapy using a combination of anti-TNFα (infliximab) and an immunomodulator is cost effective in the treatment of Crohn’s disease compared to treatment cycles in which the immunomodulator is withdrawn. Combination treatment is cost effective compared to treatment cycles in which infliximab is withdrawn, at prices of infliximab below € 192/100 mg, given a willingness-to-pay threshold at € 49 020 (Sweden) per additional QALY.
PMID: 30893421 [PubMed – as supplied by publisher]