In:
Gut, BMJ, Vol. 69, No. 4 ( 2020-04), p. 658-664
Kurzfassung:
To evaluate the cost-effectiveness of an inflammatory biomarker and clinical symptom directed tight control strategy (TC) compared with symptom-based clinical management (CM) in patients with Crohn’s disease (CD) naïve to immunosuppressants and biologics using a UK public payer perspective. Design A regression model estimated weekly CD Activity Index (CDAI)-based transition matrices (remission: CDAI 〈 150, moderate: CDAI ≥150 to 〈 300, severe: CDAI ≥300 to 〈 450, very severe: CDAI ≥450) based on the Effect of Tight Control Management on Crohn’s Disease (CALM) trial. A regression predicted hospitalisations. Health utilities and costs were applied to health states. Work productivity was monetised and included in sensitivity analyses. Remission rate, CD-related hospitalisations, adalimumab injections, other direct medical costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated. Results Over 48 weeks, TC was associated with a higher clinical remission (CDAI 〈 150) rate (58.2% vs 46.8%), fewer CD-related hospitalisations (0.124 vs 0.297 events per patient) and more injections of adalimumab (40 mg sc) (mean 31.0 vs 24.7) than CM. TC was associated with 0.032 higher QALYs and £593 higher total medical costs. The ICER was £18 656 per QALY. The ICER was cost-effective in 57.9% of simulations. TC became dominant, meaning less costly but more effective, when work productivity was included. Conclusion A TC strategy as used in the CALM trial is cost-effective compared with CM. Incorporating costs related to work productivity increases the economic value of TC. Cross-national inferences from this analysis should be made with caution given differences in healthcare systems. Trial registration number NCT01235689 ; Results.
Materialart:
Online-Ressource
ISSN:
0017-5749
,
1468-3288
DOI:
10.1136/gutjnl-2019-318256
Sprache:
Englisch
Verlag:
BMJ
Publikationsdatum:
2020
ZDB Id:
1492637-4
