A model of the long-term cost effectiveness of scheduled maintenance treatment with infliximab for moderate-to-severe ulcerative colitis.
BACKGROUND
Infliximab (IFX) has been shown to be efficacious in moderate-severe ulcerative colitis (UC). Aim To evaluate the cost-effectiveness of a scheduled maintenance treatment (SMT) with IFX in moderate-severe UC patients.


METHODS
A Markov model was constructed to simulate the progression of a cohort of moderate-severe UC patients treated with IFX (5 mg/kg) SMT. Transitions were estimated from two phase III trials of IFX (ACT I and ACT II). Standard care, comprising immunomodulators and/or corticosteroids was used as a comparator. Two separate treatment strategies were evaluated - continued treatment in IFX responders and continued treatment in IFX patients achieving remission. The dose of IFX was estimated for a 73 kg typical UC patient in the UK. The results were calculated over 10 years using a discount rate of 3.5% for costs and outcomes. The outcome measure was quality-adjusted life years (QALYs) estimated using EQ-5D. Sensitivity analyses explored the uncertainty around the results.


RESULTS
The incremental cost effectiveness ratio (ICER) for IFX was 27,424 pounds in the responder strategy and 19,696 pounds in the remission strategy at 10 years. In sensitivity analysis, the ICER for IFX in the responder strategy ranged from 21,066 pounds to 86,322 pounds and in the remission strategy ranged from 14,728 pounds to 46,765 pounds. The model time horizon and patient body weight were important factors affecting results.


CONCLUSIONS
Eight-week SMT with IFX appears to be a cost-effective treatment option for adult patients suffering from moderate to severe UC.
Tsai
H H
HH
Department of Gastroenterology, Castle Hill Hospital, Cottingham and Hull York Medical School, UK.
Punekar
Y S
YS
Morris
J
J
Fortun
P
P
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage* / Q000191:economics; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000191:economics; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D004334:Drug Administration Schedule; D017048:Health Care Costs; D006801:Humans; D000069285:Infliximab; D008390:Markov Chains; D008954:Models, Biological; D019057:Quality-Adjusted Life Years; D013997:Time Factors; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D000911:Antibodies, Monoclonal; D000069285:Infliximab