Diana M Negoescu1, Eva A Enns2, Brooke Swanhorst1, Bonnie Baumgartner1, James P Campbell3, Mark T Osterman4, Konstantinos Papamichael5, Adam S Cheifetz5, Byron P Vaughn3. 1. Department of Industrial and Systems Engineering, University of Minnesota College of Science and Engineering, Minneapolis, MN. 2. Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN. 3. Division of Gastroenterology, Hepatology and Nutrition, University of Minnesota Medical School, Minneapolis, MN. 4. Division of Gastroenterology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 5. Center for Inflammatory Bowel Disease, Beth-Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Abstract
BACKGROUND: Therapeutic drug monitoring (TDM) is increasingly performed for Infliximab (IFX) in patients with Crohn's disease (CD). Reactive TDM is a cost-effective strategy to empiric IFX dose escalation. The cost-effectiveness of proactive TDM is unknown. The aim of this study is to assess the cost-effectiveness of proactive vs reactive TDM in a simulated population of CD patients on IFX. METHODS: We developed a stochastic simulation model of CD patients on IFX and evaluated the expected health costs and outcomes of a proactive TDM strategy compared with a reactive strategy. The proactive strategy measured IFX concentration and antibody status every 6 months, or at the time of a flare, and dosed IFX to a therapeutic window. The reactive strategy only did so at the time of a flare. RESULTS: The proactive strategy led to fewer flares than the reactive strategy. More patients stayed on IFX in the proactive vs reactive strategy (63.4% vs 58.8% at year 5). From a health sector perspective, a proactive strategy was marginally cost-effective compared with a reactive strategy (incremental cost-effectiveness ratio of $146,494 per quality-adjusted life year), assuming a 40% of the wholesale price of IFX. The results were most sensitive to risk of flaring with a low IFX concentration and the cost of IFX. CONCLUSIONS: Assuming 40% of the average wholesale acquisition cost of biologic therapies, proactive TDM for IFX is marginally cost-effective compared with a reactive TDM strategy. As the cost of infliximab decreases, a proactive monitoring strategy is more cost-effective.
BACKGROUND: Therapeutic drug monitoring (TDM) is increasingly performed for Infliximab (IFX) in patients with Crohn's disease (CD). Reactive TDM is a cost-effective strategy to empiric IFX dose escalation. The cost-effectiveness of proactive TDM is unknown. The aim of this study is to assess the cost-effectiveness of proactive vs reactive TDM in a simulated population of CDpatients on IFX. METHODS: We developed a stochastic simulation model of CDpatients on IFX and evaluated the expected health costs and outcomes of a proactive TDM strategy compared with a reactive strategy. The proactive strategy measured IFX concentration and antibody status every 6 months, or at the time of a flare, and dosed IFX to a therapeutic window. The reactive strategy only did so at the time of a flare. RESULTS: The proactive strategy led to fewer flares than the reactive strategy. More patients stayed on IFX in the proactive vs reactive strategy (63.4% vs 58.8% at year 5). From a health sector perspective, a proactive strategy was marginally cost-effective compared with a reactive strategy (incremental cost-effectiveness ratio of $146,494 per quality-adjusted life year), assuming a 40% of the wholesale price of IFX. The results were most sensitive to risk of flaring with a low IFX concentration and the cost of IFX. CONCLUSIONS: Assuming 40% of the average wholesale acquisition cost of biologic therapies, proactive TDM for IFX is marginally cost-effective compared with a reactive TDM strategy. As the cost of infliximab decreases, a proactive monitoring strategy is more cost-effective.
Authors: Niels Vande Casteele; Marc Ferrante; Gert Van Assche; Vera Ballet; Griet Compernolle; Kristel Van Steen; Steven Simoens; Paul Rutgeerts; Ann Gils; Séverine Vermeire Journal: Gastroenterology Date: 2015-02-24 Impact factor: 22.682
Authors: Elana A Maser; Renata Villela; Mark S Silverberg; Gordon R Greenberg Journal: Clin Gastroenterol Hepatol Date: 2006-08-22 Impact factor: 11.382
Authors: Jean-Frédéric Colombel; William J Sandborn; Paul Rutgeerts; Robert Enns; Stephen B Hanauer; Remo Panaccione; Stefan Schreiber; Dan Byczkowski; Ju Li; Jeffrey D Kent; Paul F Pollack Journal: Gastroenterology Date: 2006-11-29 Impact factor: 22.682
Authors: Konstantinos Papamichael; Karen A Chachu; Ravy K Vajravelu; Byron P Vaughn; Josephine Ni; Mark T Osterman; Adam S Cheifetz Journal: Clin Gastroenterol Hepatol Date: 2017-03-30 Impact factor: 11.382
Authors: Christopher W Teshima; Adrienne Thompson; LeRose Dhanoa; Levinus A Dieleman; Richard N Fedorak Journal: Can J Gastroenterol Date: 2009-05 Impact factor: 3.522
Authors: Brian G Feagan; William J Sandborn; Christopher Gasink; Douglas Jacobstein; Yinghua Lang; Joshua R Friedman; Marion A Blank; Jewel Johanns; Long-Long Gao; Ye Miao; Omoniyi J Adedokun; Bruce E Sands; Stephen B Hanauer; Severine Vermeire; Stephan Targan; Subrata Ghosh; Willem J de Villiers; Jean-Frédéric Colombel; Zsolt Tulassay; Ursula Seidler; Bruce A Salzberg; Pierre Desreumaux; Scott D Lee; Edward V Loftus; Levinus A Dieleman; Seymour Katz; Paul Rutgeerts Journal: N Engl J Med Date: 2016-11-17 Impact factor: 91.245
Authors: Elliot Marseille; Bruce Larson; Dhruv S Kazi; James G Kahn; Sydney Rosen Journal: Bull World Health Organ Date: 2014-12-15 Impact factor: 9.408
Authors: Christian Primas; Walter Reinisch; John C Panetta; Alexander Eser; Diane R Mould; Thierry Dervieux Journal: J Clin Med Date: 2022-06-09 Impact factor: 4.964