title: Cost-effectiveness of early colectomy with ileal pouch-anal anastamosis versus standard medical therapy in severe ulcerative colitis.
abstract: BACKGROUND
  Inflammatory bowel diseases are costly chronic gastrointestinal diseases. We aimed to determine whether immediate colectomy with ileal pouch-anal anastamosis (IPAA) after diagnosis of severe ulcerative colitis (UC) was cost-effective compared to the standard medical therapy.
  
  
  METHODS
  We created a Markov model simulating 2 cohorts of 21-year-old patients with severe UC, following them until 100 years of age or death, comparing early colectomy with IPAA strategy to the standard medical therapy strategy. Deterministic and probabilistic analyses were performed.
  
  
  RESULTS
  Standard medical care accrued a discounted lifetime cost of $236,370 per patient. In contrast, early colectomy with IPAA accrued a discounted lifetime cost of $147,763 per patient. Lifetime quality-adjusted life-years gained (QALY-gained) for standard medical therapy was 20.78, while QALY-gained for early colectomy with IPAA was 20.72. The resulting incremental cost-effectiveness ratio (Δcosts/ΔQALY) was approximately $1.5 million per QALY-gained. Results were robust to one-way sensitivity analyses for all variables in the model. Quality-of-life after colectomy with IPAA was the most sensitive variable impacting cost-effectiveness. A low utility value of less than 0.7 after colectomy with IPAA was necessary for the colectomy with IPAA strategy to be cost-ineffective.
  
  
  CONCLUSIONS
  Under the appropriate clinical settings, early colectomy with IPAA after diagnosis of severe UC reduces health care expenditures and provides comparable quality of life compared to exhaustive standard medical therapy.
authors.affiliation: Stanford University Medical Center, Lucile Packard Children's Hospital, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Palo Alto, CA 94304, USA.
authors.forename: K T
authors.initials: KT
authors.lastname: Park
authors.forename: Raymond
authors.initials: R
authors.lastname: Tsai
authors.forename: Felipe
authors.initials: F
authors.lastname: Perez
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Cipriano
authors.forename: Dorsey
authors.initials: D
authors.lastname: Bass
authors.forename: Alan M
authors.initials: AM
authors.lastname: Garber
mesh_terms: D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003082:Colectomy / Q000191:economics*; D003093:Colitis, Ulcerative / Q000188:drug therapy* / Q000191:economics / Q000601:surgery*; D039021:Colonic Pouches / Q000191:economics*; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab; D008390:Markov Chains; D009010:Monte Carlo Method; D011788:Quality of Life; D013997:Time Factors
chemical_list: D000911:Antibodies, Monoclonal; D005765:Gastrointestinal Agents; D000069285:Infliximab