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A Microsimulation Model to Project the 5-Year Impact of Using Hyperbaric Oxygen Therapy for Ulcerative Colitis Patients Hospitalized for Acute Flares

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Abstract

Background

Hyperbaric oxygen therapy (HBOT) improves short-term outcomes for ulcerative colitis (UC) patients hospitalized for acute flares. Longer-term impacts and cost-effectiveness are unknown.

Methods

We compared disease outcomes and cost-effectiveness of HBOT in addition to standard of care versus standard of care alone for UC patients hospitalized for acute flares using a microsimulation model. Published literature was used for transition probabilities, costs, and quality-adjusted life year (QALY) estimates. We modeled 100,000 individuals in each group over a 5-year horizon and compared rates of re-hospitalization, rescue medical therapy, colectomy, death, and cost-effectiveness at a willingness-to-pay of $100,000/QALY. Probabilistic sensitivity analyses were performed with 500 samples and 250 trials, in addition to multiple microsimulation sensitivity analyses.

Results

The use of HBOT at the time of index hospitalization for an acute UC flare is projected to reduce the risk of re-hospitalization, inpatient rescue medical therapy, and inpatient emergent colectomy by over 60% (p < 0.001) and mortality by over 30% (p <0.001), during a 5-year horizon. The HBOT strategy costs more ($5600 incremental cost) but also yielded higher QALYs (0.13 incremental yield), resulting in this strategy being cost-effective ($43,000/QALY). Results were sensitive to HBOT costs and rates of endoscopic improvement with HBOT. Probabilistic sensitivity analyses observed HBOT to be more cost-effective than standard of care in 95% of iterations.

Conclusion

The use of HBOT to optimize response to steroids during the index hospitalization for an acute UC flare is cost-effective and is projected to result in significant reductions in disease-related complications in the long term.

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Acknowledgments

Parambir S. Dulai is supported by an American Gastroenterology Association Research Scholar Award. This study was supported in part by NIDDK-funded San Diego Digestive Diseases Research Center (P30 DK120515).

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Authors and Affiliations

  1. Division of Gastroenterology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA

    Parambir S. Dulai

  2. Western University, London, ON, Canada

    Vipul Jairath

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Contributions

PSD and VJ created the study concept and design, PSD acquired the data from literature for estimates, PSD conducted the model building and analyses, PSD and VJ drafted and finalized the manuscript.

Corresponding author

Correspondence to Parambir S. Dulai.

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Conflict of interest

PSD reports consulting and research grants from Takeda, Janssen, Pfizer, Abbvie, Buhlmann, Polymedco. VJ reports consulting fees from Abbvie, Eli Lilly, GlaxoSmithKline, Arena pharmaceuticals, Genetech, Pendopharm, Sandoz, Merck, Takeda, Janssen, Robarts Clinical Trials, Topivert, Celltrion; speakers reports fees from Takeda, Janssen, Shire, Ferring, Abbvie, Pfizer.

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Supplementary Figure

 1: Two-way sensitivity analysis for rates of endoscopic improvement with hyperbaric oxygen therapy and infliximab when comparing hyperbaric oxygen therapy in combination with intravenous steroids versus up-front infliximab on day 1 plus steroids of hospitalization. HBOT: Hyperbaric oxygen therapy; IFX: infliximab; pHBOTMH: probability of achieving endoscopic improvements (Mayo endoscopic sub-score 0 or 1) with HBOT; pIFXMH: probability of achieving endoscopic improvements with infliximab; WTP: willingness-to-pay (TIFF 3804 kb)

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Dulai, P.S., Jairath, V. A Microsimulation Model to Project the 5-Year Impact of Using Hyperbaric Oxygen Therapy for Ulcerative Colitis Patients Hospitalized for Acute Flares. Dig Dis Sci 66, 3740–3752 (2021). https://doi.org/10.1007/s10620-020-06707-3

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