Cost-effectiveness of infliximab for the treatment of acute exacerbations of ulcerative colitis
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Infliximab has been shown to be efficacious in acute exacerbations of ulcerative colitis (UC).
To evaluate the cost-effectiveness of infliximab treatment in patients hospitalised with acute exacerbations of UC.
A decision analysis model was constructed to simulate the progression of acute UC patients treated with infliximab induction regimen over 1 year. Infliximab treatment was compared with standard care, ciclosporin and surgery using transitions derived from infliximab and ciclosporin randomised trials. Costs and outcomes were discounted at 3.5%. Intermediate outcomes of colectomy and post-surgery complications were translated into the primary effectiveness measurement, which was quality-adjusted life years (QALYs) estimated using EQ-5D. One-way and probabilistic sensitivity analyses were performed to estimate the uncertainty around the results.
The incremental cost effectiveness ratio (ICER) for infliximab was £19,545 per QALY compared to ciclosporin, which in turn dominated standard care. Sensitivity analysis indicated patient body weight, utility estimates and treatment effect of alternative treatment strategies to be the most important factors affecting cost-effectiveness.
Infliximab induction regimen appears to be a cost-effective treatment option for UC patients hospitalised with an acute exacerbation.
- Carter, M.J., Lobo, A.J., Travis, S.P.: Guidelines for the management of inflammatory bowel disease in adults. Gut 53(5), V1–V16 (2004) CrossRef
- Jarnerot, G., Rolny, P., Sandberg-Gertzen, H.: Intensive intravenous treatment of ulcerative colitis. Gastroenterology 89(5), 1005–1013 (1985)
- Truelove, S.C., Jewell, D.P.: Intensive intravenous regimen for severe attacks of ulcerative colitis. Lancet 1(7866), 1067–1070 (1974) CrossRef
- Leiper, K., Lowe, D., Driscoll, R., et al.: UK IBD audit 2006: National results for the organisation and process of IBD care in the UK. Published 2007; available at http://www.rcplondon.ac.uk/college/ceeu/ceeu_uk_ibd_audit_2006.pdf
- Travis, S., Trange, E., Lemann, A., et al.: European evidence based consensus on the diagnosis and management of ulcerative colitis: current management. J. Crohn’s Colitis 2, 24–62 (2008) CrossRef
- Arts, J., D’Haens, G., Zeegers, M., et al.: Long-term outcome of treatment with intravenous cyclosporin in patients with severe ulcerative colitis. Inflam. Bowel Dis. 10, 73–78 (2004) CrossRef
- Sandborn, W.J.: A critical review of cyclosporine therapy in inflammatory bowel disease. Inflam. Bowel Dis. 1, 48–63 (1995) CrossRef
- Jarnerot, G., Hertervig, E., Friis-liby, I., et al.: Infliximab as rescue therapy in severe to moderately severe ulcerative colitis: a randomized placebo controlled study. Gastroenterology 128, 1805–1811 (2005) CrossRef
- Sands, B.E., Tremaine, W.J., Sandborn, W.J., Rutgeerts, P.J., Hanauer, S.B., Mayer, L., Targan, S.R., Podolsky, D.K.: Infliximab in the treatment of severe, steroid-refractory ulcerative colitis: a pilot study. Inflam. Bowel Dis. 7(2), 83–88 (2001) CrossRef
- Tsai, H.H., Punekar, Y.S., Morris, J., et al.: A model of the long-term cost effectiveness of scheduled maintenance treatment with infliximab for moderate-to-severe ulcerative colitis. Aliment. Pharmacol. Ther. 15;28(10), 1230–1239 (2008) CrossRef
- D’Haens, G., Lemmens, L., Geboes, K., et al.: Intravenous cyclosporine versus intravenous corticosteroids as single therapy for severe attacks of ulcerative colitis. Gastroenterology 120(6), 1323–1329 (2001) CrossRef
- Lichtiger, S., Present, D.H., Kornbluth, A., et al.: Cyclosporine in severe ulcerative colitis refractory to steroid therapy. N. Engl. J. Med. 330(26), 1841–1845 (1994) CrossRef
- Ades, A., Welton, N., Caldwell, D., et al.: Multiparameter evidence synthesis in epidemiology and medical decision-making. J. Health Serv. Res. Policy 13(Suppl 3), 12–22 (2008) CrossRef
- Lunn, D.J., Thomas, A., Best, N., Spiegelhalter, D.: WinBUGS–a Bayesian modelling framework: concepts, structure, and extensibility. Stat. Comput. 10, 325–337 (2000) CrossRef
- Reference costs 2006/07: National schedule of reference costs. Department of Health. January 2008
- Woehl, A., Hawthorne, B., Morgan, C., Punekar, Y., McEwan, P.: The epidemiology and healthcare resource use in patients with Crohn’s disease: a population based UK study. Value Health 10(6), A355 (2007)
- Dolan, P.: Modeling valuations for EuroQol health states. Med. Care 35(11), 1095–1108 (1997) CrossRef
- Walmsley, R.S., Ayres, R.C.S., Pounder, R.E., Allan, R.N.: A simple clinical colitis activity index. Gut 43(10), 29–32 (1998) CrossRef
- Arseneau, K., Sultan, S., Provenzale, D., et al.: Do patient preferences influence decisions on treatment for patients with steroid refractory ulcerative colitis? Clin. Gastroenterol. Hepatol. 4(9), 1135–1142 (2006) CrossRef
- National Institute of Health and Clinical Excellence (NICE): Guide to the Methods of Technology Appraisal (reference NO515). NICE, London, (2004), http://www.nice.org.uk/niceMedia/pdf/TAP_Methods.pdf
- Kohn, A., Daperno, M., Armuzzi, A., et al.: Infliximab in severe ulcerative colitis: short-term results of different infusion regimens and long-term follow-up. Aliment. Pharmacol. Ther. 26(5), 747–756 (2007) CrossRef
- National Institute of Health and Clinical Excellence (NICE). Guidance on the Use of Infliximab for Psoriasis. London: Technology Appraisal Guidance 134, January (2008), http://www.nelm.nhs.uk/en/NeLM-Area/Evidence/Guidelines/NICE-guidance-on-the-use-of-infliximab-for-the-treatment-of-psoriasis/
- Laharie, D.: A randomized, multicenter open label study comparing cyclosporine with infliximab in steroid-refractory severe attacks of ulcerative colitis (CYSIF). Clinicaltrials.gov identifier–NCT00542152, http://clinicaltrials.gov/ct2/show/NCT00542152
- Cost-effectiveness of infliximab for the treatment of acute exacerbations of ulcerative colitis
The European Journal of Health Economics
Volume 11, Issue 1 , pp 67-76
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