Health-economic analysis: cost-effectiveness of scheduled maintenance treatment with infliximab for Crohn's disease--modelling outcomes in active luminal and fistulizing disease in adults.
BACKGROUND
Infliximab has been shown to be efficacious in moderate-to-severe Crohn's disease (CD).


OBJECTIVE
To evaluate the cost-effectiveness of scheduled maintenance treatment with infliximab in luminal and fistulizing CD patients.


METHODS
Markov models were constructed to simulate the progression of adult CD patients with and without fistulae during treatment with infliximab (5 mg/kg). Transitions were estimated from published clinical trials of infliximab. Standard care, comprising immunomodulators and/or corticosteroids was used as a comparator. An average weight of 60 kg was used to estimate the dose of infliximab. The costs and outcomes were discounted at 3.5% over 5 years. The primary effectiveness measurement was quality-adjusted life years (QALYs) estimated using EQ-5D. One-way and probabilistic sensitivity analyses were performed by varying the infliximab efficacy estimates, costs and utilities.


RESULTS
The incremental cost per QALY gained was pound 26,128 in luminal CD and pound 29,752 in fistulizing CD at 5 years. Results were robust and remained in the range of pound 23,752- pound 38,848 for luminal CD and pound 27,047- pound 44,206 for fistulizing CD. Patient body weight was the most important factor affecting cost-effectiveness.


CONCLUSIONS
Eight-week scheduled maintenance treatment with infliximab is a cost-effective treatment for adult patients suffering from active luminal or fistulizing CD.
Lindsay
J
J
Barts and the London NHS Trust, The Royal London Hospital, Whitechapel, London, UK. james.lindsay@bartsandthelondon.nhs.uk
Punekar
Y S
YS
Morris
J
J
Chung-Faye
G
G
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000191:economics*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000191:economics*; D001835:Body Weight / Q000187:drug effects; D003362:Cost-Benefit Analysis / Q000191:economics; D003424:Crohn Disease / Q000188:drug therapy* / Q000191:economics* / Q000601:surgery; D016527:Drug Costs; D005260:Female; D005765:Gastrointestinal Agents / Q000008:administration & dosage / Q000191:economics*; D006760:Hospitalization / Q000191:economics; D006801:Humans; D000069285:Infliximab; D007412:Intestinal Fistula / Q000188:drug therapy / Q000191:economics*; D008297:Male; D008390:Markov Chains; D008875:Middle Aged; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab