STUDY OBJECTIVE: To compare the cost versus utility of four guideline-recommended biologic treatments-infliximab, adalimumab, certolizumab pegol, and natalizumab-for the treatment of Crohn's disease from a United States payer perspective. DESIGN: Cost-utility decision analytic model using a Monte Carlo simulation of 10,000 cases. DATA SOURCE: Published primary and tertiary literature. PATIENTS: Patients with moderate-to-severe Crohn's disease, as categorized by the Crohn's Disease Activity Index, that failed to respond to standard therapy and who were treatment naive to biologics. MEASUREMENTS AND MAIN RESULTS: The decision analytic model base case was a 35-year-old patient weighing 70 kg with moderate-to-severe Crohn's disease. Therapeutic efficacy data were obtained from published clinical trials. Online prescription drug, hospitalization data, and Current Procedural Terminology codes were used to estimate cost. Utility measures were estimated using published data obtained from patients with Crohn's disease. The time end point used for the model was 54 weeks. The analysis demonstrated considerable overlap in quality-adjusted life years gained with the four agents (i.e., mean values across four treatments 0.79-0.80). Although infliximab had the lowest median cost, there was overlap in the 95% confidence intervals (CIs) compared with the other three biologic products: mean (95% CI) cost for infliximab $22,663 ($19,105-26,433), adalimumab $27,515 ($23,796-31,584), certolizumab pegol $29,062 ($24,952-33,882), and natalizumab $31,166 ($25,915-37,195). However, the cost-effectiveness acceptability curve demonstrated that infliximab had the most scenarios (95.2%) when it was the most cost-effective biologic therapy using a willingness-to-pay threshold of $100,000/quality-adjusted life years gained. CONCLUSION: Patients with moderate-to-severe Crohn's disease that failed to respond to standard treatment should preferentially receive infliximab as their initial biologic treatment, since this agent had the highest probability of being the most cost-effective therapy compared with the other biologic treatment options.
STUDY OBJECTIVE: To compare the cost versus utility of four guideline-recommended biologic treatments-infliximab, adalimumab, certolizumab pegol, and natalizumab-for the treatment of Crohn's disease from a United States payer perspective. DESIGN: Cost-utility decision analytic model using a Monte Carlo simulation of 10,000 cases. DATA SOURCE: Published primary and tertiary literature. PATIENTS: Patients with moderate-to-severe Crohn's disease, as categorized by the Crohn's Disease Activity Index, that failed to respond to standard therapy and who were treatment naive to biologics. MEASUREMENTS AND MAIN RESULTS: The decision analytic model base case was a 35-year-old patient weighing 70 kg with moderate-to-severe Crohn's disease. Therapeutic efficacy data were obtained from published clinical trials. Online prescription drug, hospitalization data, and Current Procedural Terminology codes were used to estimate cost. Utility measures were estimated using published data obtained from patients with Crohn's disease. The time end point used for the model was 54 weeks. The analysis demonstrated considerable overlap in quality-adjusted life years gained with the four agents (i.e., mean values across four treatments 0.79-0.80). Although infliximab had the lowest median cost, there was overlap in the 95% confidence intervals (CIs) compared with the other three biologic products: mean (95% CI) cost for infliximab $22,663 ($19,105-26,433), adalimumab $27,515 ($23,796-31,584), certolizumab pegol $29,062 ($24,952-33,882), and natalizumab $31,166 ($25,915-37,195). However, the cost-effectiveness acceptability curve demonstrated that infliximab had the most scenarios (95.2%) when it was the most cost-effective biologic therapy using a willingness-to-pay threshold of $100,000/quality-adjusted life years gained. CONCLUSION:Patients with moderate-to-severe Crohn's disease that failed to respond to standard treatment should preferentially receive infliximab as their initial biologic treatment, since this agent had the highest probability of being the most cost-effective therapy compared with the other biologic treatment options.
Authors: Balakrishnan S Ramakrishna; Govind K Makharia; Vineet Ahuja; Uday C Ghoshal; Venkataraman Jayanthi; Benjamin Perakath; Philip Abraham; Deepak K Bhasin; Shobna J Bhatia; Gourdas Choudhuri; Sunil Dadhich; Devendra Desai; Bhaba Dev Goswami; Sanjeev K Issar; Ajay K Jain; Rakesh Kochhar; Goundappa Loganathan; Sri Prakash Misra; C Ganesh Pai; Sujoy Pal; Mathew Philip; Anna Pulimood; Amarender S Puri; Gautam Ray; Shivaram P Singh; Ajit Sood; Venkatraman Subramanian Journal: Indian J Gastroenterol Date: 2015-03-14
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