title: Real-life treatment paradigms show infliximab is cost-effective for management of ulcerative colitis.
abstract: OBJECTIVE
  Infliximab is effective for induction and maintenance of response in patients with moderate to moderately severe ulcerative colitis. Previous cost analyses of infliximab treatment for ulcerative colitis used models of colectomy vs infliximab and response rates derived from early clinical trials. In real life, therapeutic options are more complex; patients frequently choose to remain in an unwell state rather than undergo colectomy, and rates of response to infliximab are generally higher than those reported from clinical trials. We evaluate the real-life cost-effectiveness of infliximab for treatment of ulcerative colitis where infliximab was readily available compared with not available, causing patients to remain in unwell states.
  
  
  METHODS
  We constructed a Markov model to simulate disease progression of patients with moderate or moderately severe ulcerative colitis who depended on corticosteroids and/or did not respond to thiopurine therapy. Utility scores and transition probabilities between health states were determined by using data from randomized controlled trials and real-life rates published by expert inflammatory bowel disease centers. Health care costs were obtained from the Ontario Case Costing Initiative and the Alberta Health Schedule of Medical Benefits documents.
  
  
  RESULTS
  The incremental cost-effectiveness ratios for infliximab treatment of ulcerative colitis were $79,000 and $64,000 per quality-adjusted life year, compared with ongoing medical therapy, at 5-year and 10-year treatment time horizons, respectively.
  
  
  CONCLUSIONS
  By using real-life response rates and patients' preference to avoid colectomy, infliximab therapy is a cost-effective strategy at a willingness-to-pay threshold of $80,000 for treatment of ulcerative colitis.
authors.affiliation: Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Victoria
authors.initials: V
authors.lastname: Ung
authors.affiliation: Institute of Health Economics, Edmonton, Alberta, Canada.
authors.forename: Nguyen Xuan
authors.initials: NX
authors.lastname: Thanh
authors.affiliation: Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Wong
authors.affiliation: Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Karen I
authors.initials: KI
authors.lastname: Kroeker
authors.affiliation: Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Thomas
authors.initials: T
authors.lastname: Lee
authors.affiliation: Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Haili
authors.initials: H
authors.lastname: Wang
authors.affiliation: Institute of Health Economics, Edmonton, Alberta, Canada.
authors.forename: Arto
authors.initials: A
authors.lastname: Ohinmaa
authors.affiliation: Institute of Health Economics, Edmonton, Alberta, Canada.
authors.forename: Philip
authors.initials: P
authors.lastname: Jacobs
authors.affiliation: Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada. Electronic address: richard.fedorak@ualberta.ca.
authors.forename: Richard N
authors.initials: RN
authors.lastname: Fedorak
mesh_terms: D000328:Adult; D000416:Alberta; D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use*; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D005260:Female; D006801:Humans; D007155:Immunologic Factors / Q000191:economics* / Q000627:therapeutic use*; D000069285:Infliximab; D008297:Male; D009864:Ontario; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007155:Immunologic Factors; D000069285:Infliximab
keywords: Corticosteroid; Cost-Utility Analysis; ICER; Inflammatory Bowel Disease; Proctocolectomy