title: Cost-Utility Analysis of Infliximab with Standard Care versus Standard Care Alone for Induction and Maintenance Treatment of Patients with Ulcerative Colitis in Poland.
abstract: OBJECTIVE
  To assess the cost-effectiveness of infliximab with standard care (e.g., azathioprine, prednisolone, mesalazine, and 6-mercaptopurine) versus standard care alone for induction and maintenance treatment of patients with ulcerative colitis (UC) in Poland.
  
  
  METHODS
  Cost-utility decision analytic model.
  
  
  RESULTS
  A Markov model was used to estimate the expected costs and effects of infliximab/standard care and standard care alone. For each treatment option, costs and quality-adjusted life-years (QALYs) were calculated to estimate the incremental cost-utility ratio. The target population consisted of a hypothetical cohort of adult patients with moderately to severely active UC who had an inadequate response to standard treatment, including corticosteroids and 6-mercaptopurine or azathioprine, or who were intolerant to or had medical contraindications to such therapies. The analysis was performed from the perspective of the Polish public payer over a 30-year time horizon. The clinical parameters were derived mainly from the Active Ulcerative Colitis Trial (ACT) 1 and ACT 2 and from the Ulcerative Colitis Long-term Remission and Maintenance with Adalimumab (ULTRA) 2 clinical trial. Different costs and utility values were assigned to the various health states in the model; utility values were derived from a previously published study. Treatment of patients who received infliximab/standard care instead of standard care alone resulted in 0.174 additional QALYs. Treatment with infliximab/standard care was found to be more expensive than treatment with standard care alone from the Polish National Health Fund perspective. The incremental cost-utility ratio of infliximab/standard care compared with standard care alone was estimated to be 402,420 Polish zlotys (PLN)/QALY gained (95% confidence interval [CI] 253,936-531,450 PLN/QALY gained), which is equivalent to $106,743 (U.S. dollars)/QALY gained (95% CI $67,357-140,968 [U.S. dollars]/QALY gained).
  
  
  CONCLUSIONS
  Treatment with infliximab/standard care instead of standard care alone resulted in additional QALYs but also additional costs. The incremental cost per QALY gained of infliximab/standard care compared with standard care alone exceeded the willingness-to-pay threshold in Poland (equivalent to ~$33,400).
authors.affiliation: Statsoft Polska Sp. z o.o., Krakow, Poland.
authors.forename: Ewa
authors.initials: E
authors.lastname: Stawowczyk
authors.affiliation: Drug Management Department, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Kawalec
authors.affiliation: Department of Neurobiology, Institute of Pharmacology, Polish Academy of Sciences, Krakow, Poland.
authors.forename: Andrzej
authors.initials: A
authors.lastname: Pilc
mesh_terms: D003093:Colitis, Ulcerative / Q000188:drug therapy / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D000069285:Infliximab / Q000191:economics* / Q000627:therapeutic use; D008390:Markov Chains; D011044:Poland; D019057:Quality-Adjusted Life Years
chemical_list: D000069285:Infliximab
keywords: cost utility; economic analysis; inflammatory bowel disorder; infliximab; ulcerative colitis