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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
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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

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