Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-17T13:21:34.715Z Has data issue: false hasContentIssue false
  • English
  • Français

Management for severe Crohn's disease: A lifetime cost-utility analysis

Published online by Cambridge University Press:  01 August 2004

Isabelle Jaisson-Hot ,
Bernard Flourié ,
Louis Descos  and
Cyrille Colin
Isabelle Jaisson-Hot
Affiliation:
Hospices Civils de Lyon
Bernard Flourié
Affiliation:
Centre Hospitalier Lyon Sud
Louis Descos
Affiliation:
Centre Hospitalier Lyon Sud
Cyrille Colin
Affiliation:
Hospices Civils de Lyon
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: Infliximab is a costly therapy for active Crohn's disease resistant to corticosteroids and immunosuppressive medication. The purpose of this study was to examine whether a treatment including infliximab (episodic re-infusions for relapse or maintenance therapy every 8 weeks) was relevant compared with conventional management (surgery and medical treatment without infliximab) for nonfistulizing resistant Crohn's disease.

Methods: We performed a life-time cost-utility analysis with an analytic Markov decision model from the perspective of the third-party payer system. Utility measurement using Standard Gamble was used to adjust the survival time for each health state of the disease. Direct costs were estimated from standard management based on expert opinion. A sensitivity analysis was conducted to gauge the effects of uncertainty in the values assigned to variables.

Results: The incremental effectiveness with infliximab therapy is .761 Quality-Adjusted Life Years (QALYs) for an added cost ranging from 48,478.79 euros to 596,990.35 euros, depending on treatment procedure. The incremental cost utility ratio expressed in euros per QALYs saved varied from 63,700.82 euros (episodic re-infusions) to over 762,245.09 euros (maintenance therapy).

Conclusions: Infliximab therapy could be cost-effective in the case of relapse treatment only, whereas the marginal cost-utility ratio exceeds conventional benchmarks for maintenance therapy. This analysis will be supplemented by conducting further randomized controlled trials and prospective observational study, focused on the costs of illness (direct and indirect), patient preferences, the disease's clinical course, and infliximab safety.

Keywords

Cost of illnessQuality of lifeCrohn's disease
Type
GENERAL ESSAYS
Information
International Journal of Technology Assessment in Health Care , Volume 20 , Issue 3 , August 2004 , pp. 274 - 279
Copyright
© 2004 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arseneau KO, Cohn SM, Cominelli F, Connors AF. 2001 Cost-utility of initial medical management for Crohn's disease perianal fistulae. Gastroenterology. 120: 1640– 1656.Google Scholar
Beck RJ, Pauker SG. 1983 The Markov process in medical prognosis. Med Decis Making. 3: 419– 458.Google Scholar
BlomqVist P, Ekbom A. 1997 Inflammatory bowel diseases: Health care and costs in Sweden in 1994. Scand J Gastroenterol. 32: 1134– 1139.Google Scholar
Casellas F, Lopez-Vivancos J, Badia X, Vilaesca J, Malagelada JR. 2000 Impact of surgery for Crohn's disease on health-related quality of life. Am J Gastroenterol. 95: 177– 182.Google Scholar
Colin C. 1995 Les analyses de décision. In: Landrivon G, Delahaye F, editors. La recherche clinique. Paris: Masson
Drossman DA, Patrick DL, Mitchell CM, Zagami EA, Appelbaum MI. 1989 Health-related quality of life in inflammatory bowel disease. Functional status and patient worries and concerns. Dig Dis Sci. 34: 1379– 1386.Google Scholar
Drummond M, O'Brien B, Stoddart G, Torrance G. 1998 Méthodes d'évaluation économique des programmes de santé. 2nd ed. Edts Economica
Fasth S, Helberg R, Hulten L, Magnusson O. 1980 Early complications after surgical treatment for Crohn's disease with particular reference for factors affecting their development. Acta Chir Scand. 146: 519– 526.Google Scholar
Gregor JC, McDonald JWD, Klar N, et al. 1997 An evaluation of utility measurement in Crohn's disease. Inflamm Bowel Dis. 3: 265– 276.Google Scholar
Garrett JW, Drossman DA. 1990 Health status in inflammatory bowel disease. Biological and behavioral considerations. Gastroenterology. 99: 90– 98.Google Scholar
Hanauer SB. 2001 Maintenance infliximab (Remicade) is safe, effective and steroid-sparing in Crohn's disease: Preliminary results from the Accent I trial. Digestive Disease Week (Atlanta)
Heimann TM, Greenstein AJ, Mechanic L, Aufses AH. 1985 Early complications following surgical treatment for Crohn's disease. Ann Surg. 201: 494– 498.Google Scholar
Hurst RD, Molinari M, Chung TP, Rubin M, Michelassi F. 1997 Prospective study of the features, indications, and surgical treatment in 513 consecutive patients affected by Crohn's disease. Surgery. 122: 661– 668.Google Scholar
Launois R, Croutsche JJ, Megnigbeto AC, Le Lay K, Portafax C. 1999 L'apport indispensable de l'épidémiologie clinique aux modèles de Markov. JEM. 17: 343– 361.Google Scholar
Le Gales C, Triomphe A. 1991 L'évaluation économique des interventions en santé publique: Principes et limites. Rev Epidém et santé Publ. 39: 15– 29.Google Scholar
Love JR, Irvine EJ, Fedorak RN. Quality of life in inflammatory bowel disease. J Clin Gastroenterol. 1992 14: 15– 19.Google Scholar
Mekhjian HS, Switz DM, Watts HD, et al. National Cooperative Crohn's Disease Study: Factors determining recurrence of Crohn's disease after surgery. Gastroenterology. 1979 77: 907– 913.Google Scholar
Mekhjian HS, Switz DM, Melnyck CS, Rankin GB, Brooks RK. Clinical features and natural history of Crohn's disease. Gastroenterology. 1979 77: 898– 906.Google Scholar
Messori A, Brignola C, Trallori G, et al. 1994 Effectiveness of 5-Aminosalicylic Acid for maintaining remission in patients with Crohn's disease: A meta-analysis. Am J Gastroenterol. 89: 692– 698.Google Scholar
Munkholm P, Langholz E, Davidsen M, Binder V. 1993 Intestinal cancer risk and mortality in patients with Crohn's disease. Gastroenterolgy. 105: 1716– 1723.Google Scholar
O'Donoghue DP, Dawson AM, Powell-Tuck, Bown RL, Lennard-Jones JE. 1978 Doubleblind withdrawal trial of Azathioprine as maintenance treatment for Crohn's disease. Lancet. 2: 955– 957.Google Scholar
Present DH, Rutgeerts P, Targan, et al. 1999 Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med. 340: 1398– 1405.Google Scholar
Silverstein MD, Loftus EV, Sandborn WJ, et al. 1999 Clinical course and costs of care for Crohn's disease: Markov model analysis of a population-based cohort. Gastroenterology. 117: 49– 57.Google Scholar
Targan SR, Hanauer SB, Van Deventer SJH, et al. 1997 A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor α for Crohn's disease. N Engl J Med. 337: 1029– 1035.Google Scholar
Tillinger W, Mittermaier C, Lochs H, Moser G. 1999 Health-related quality of life in patients with Crohn's disease. Influence of surgical operation—A prospective trial. Dig Dis Sci. 44: 932– 938.Google Scholar
Torrance GW. 1986 Measurement of health-state utilities for economic appraisal: A review. J Health Econ. 5: 1– 30.Google Scholar
Whelan G, Farmer RG, Fazio VW, Goormastic M. 1985 Recurrence after surgery in Crohn's disease. Relationship to location of disease (Clinical pattern) and surgical indication. Gastroenterology. 88: 1826– 1833.Google Scholar
Wong JB, Loftus EV, Feagan BG. 1999 Estimating the cost-effectiveness of Infliximab for Crohn's disease. Gastroenterology. 116: A399– A400.Google Scholar
Wright JC, Weinstein MC. Gains in life expectancy from medical interventions—Standardizing data on outcomes. N Engl J Med. 1998 339: 380– 386.Google Scholar