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Cost-Effectiveness of Reimbursing Infliximab for Moderate to Severe Crohn’s Disease in China

Abstract

Objectives

To assess the cost-effectiveness of reimbursing infliximab for moderate-to-severe Crohn’s disease (MS-CD) in China from the perspective of public insurance payers.

Methods

A decision-analytic model with a lifetime time horizon was constructed to simulate the disease progression and direct medical costs in Chinese MS-CD patients under two scenarios: reimbursing infliximab vs. not reimbursing infliximab. A cross-sectional study and literature review were conducted to estimate model variables. The constructed decision-analytic model ran the base case, one-way sensitivity, and probabilistic sensitivity analyses (PSA) to assess the cost-effectiveness of reimbursing infliximab using reimbursed medical costs.

Results

Base case analysis discounting health benefits and costs estimated that reimbursing infliximab could increase overall survival by 0.604 years, increase total quality-adjusted life years (QALY) by 0.697 QALY, reduce absolute lifetime surgery risk by 13.1%, and increase reimbursed costs by ¥29,409. The incremental cost-effectiveness ratio per gained additional QALY (ICER) based on discounted health benefits and reimbursed medical costs (3% per year) was ¥42,198. The one-way sensitivity analyses identified that the cost-effectiveness of reimbursing infliximab for MS-CD was mainly driven by the treatment efficacies of maintenance therapy, quality of life, and unit price of infliximab. PSA estimated that reimbursing infliximab was associated with a 63.8% chance to be cost-effective under the willingness-to-pay of the 2018 Chinese gross domestic product per capita (GDPPC).

Conclusion

Reimbursing infliximab for MS-CD in Chinese patients was highly attractive, costing Chinese public insurance payers less than the 2018 Chinese GDPPC to gain 1 QALY.

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Acknowledgements

Funding

This work was supported by Zhejiang Medical and Health Science and Technology project (grant number 2020KY608).

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authorship Contributions

Qian Cao and Wendong Chen formulated the research idea. Haotian Chen, Jihao Shi, Ying Chen, Wendong Chen, and Qian Cao developed the study protocol. Haotian Chen, Jihao Shi, Yipeng Pan, Zhou Zhang, and Hao Fang conducted the patient identification, data extraction, and patient survey of the cross-sectional study in this manuscript. Ying Chen and Wendong Chen conducted the data analysis. Haotian Chen, Jihao Shi, Wendong Chen, and Qian Cao developed the manuscript. All authors have critically reviewed the manuscript and approved this manuscript submission.

Compliance with Ethics Guidelines

Ethics approval for this study was obtained from Sir Run Run Shaw Hospital.

Disclosures

Ying Chen is employed by a consulting firm that receives industry funds to conduct health economics and outcome research. Wendong Chen is employed by a consulting firm that receives industry funds to conduct health economics and outcome research. All other authors (Haotian Chen, Jihao Shi, Yipeng Pan, Zhou Zhang, Hao Fang, Qian Cao) have nothing to disclose.

Data Availability

The datasets during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Correspondence to Qian Cao.

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Chen, H., Shi, J., Pan, Y. et al. Cost-Effectiveness of Reimbursing Infliximab for Moderate to Severe Crohn’s Disease in China. Adv Ther 37, 431–449 (2020). https://doi.org/10.1007/s12325-019-01150-x

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Keywords

  • Chinese
  • Costs
  • Crohn’s disease
  • Infliximab
  • QALY
  • Reimbursement
  • Surgery