title: Biological therapies in Crohn's disease: are they cost-effective? A critical appraisal of model-based analyses.
abstract: In refractory Crohn's disease, anti-TNF and anti-α 4 integrin agents are used for ameliorating disease activity but impose high costs to health-care systems. The authors systematically reviewed cost-effectiveness analyses based on decision models: most of the studies were judged to have a good quality, but a large portion assessed health and costs in a short time horizon, usually disregarding fistulizing disease and not considering safety. Infliximab induction followed by on-demand retreatment consistently proved to have a good cost per quality-adjusted life year, while maintenance treatment never satisfied commonly accepted cost-utility thresholds. Challenges in cost-effectiveness analysis include the lack of a standard model structure, a large variability in the costs of surgery and poor data on indirect costs. As clinical practice is moving to mucosal healing as a robust response marker, personalized schedules of anti-TNF therapies might prove cost-effective even in the perspective of the health-care system in the near future.
authors.affiliation: Hematology Unit, Azienda Sanitaria Locale, Ospedale "Cardinal Massaia", Asti, Italy.
authors.forename: Monia
authors.initials: M
authors.lastname: Marchetti
authors.forename: Nicola Lucio
authors.initials: NL
authors.lastname: Liberato
mesh_terms: D000893:Anti-Inflammatory Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D001688:Biological Products / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D003424:Crohn Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics* / Q000276:immunology; D016527:Drug Costs; D005765:Gastrointestinal Agents / Q000009:adverse effects / Q000191:economics* / Q000627:therapeutic use*; D006801:Humans; D039441:Integrin alpha4 / Q000187:drug effects; D008390:Markov Chains; D018803:Models, Economic; D009010:Monte Carlo Method; D019057:Quality-Adjusted Life Years; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000893:Anti-Inflammatory Agents; D001688:Biological Products; D005765:Gastrointestinal Agents; D014409:Tumor Necrosis Factor-alpha; D039441:Integrin alpha4
keywords: cost–effectiveness analysis; crohn’s disease; decision analysis; health economics; inflammatory bowel disease