Parambir S Dulai1, Vipul Jairath2. 1. Division of Gastroenterology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA. pdulai@ucsd.edu. 2. Western University, London, ON, Canada.
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.
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.
Authors: Christopher Ma; Matthew K Smith; Leonardo Guizzetti; Remo Panaccione; Gilaad G Kaplan; Kerri L Novak; Cathy Lu; Reena Khanna; Brian G Feagan; Siddharth Singh; Vipul Jairath; Ashwin N Ananthakrishnan Journal: Clin Gastroenterol Hepatol Date: 2020-01-25 Impact factor: 11.382
Authors: Tamás Molnár; Klaudia Farkas; Tibor Nyári; Zoltán Szepes; Ferenc Nagy; Tibor Wittmann Journal: J Gastrointestin Liver Dis Date: 2011-12 Impact factor: 2.008
Authors: Alain Bitton; Donald Buie; Robert Enns; Brian G Feagan; Jennifer L Jones; John K Marshall; Scott Whittaker; Anne M Griffiths; Remo Panaccione Journal: Am J Gastroenterol Date: 2011-11-22 Impact factor: 10.864
Authors: Parambir S Dulai; Jay C Buckey; Laura E Raffals; Jason M Swoger; Paul L Claus; Kevin OʼToole; Judy A Ptak; Michael W Gleeson; Christella E Widjaja; John T Chang; Jeffery M Adler; Nihal Patel; Laurie A Skinner; Shawn P Haren; Kimberly Goldby-Reffner; Kimberly D Thompson; Corey A Siegel Journal: Am J Gastroenterol Date: 2018-02-16 Impact factor: 10.864
Authors: John G Williams; M Fasih Alam; Laith Alrubaiy; Ian Arnott; Clare Clement; David Cohen; John N Gordon; A Barney Hawthorne; Mike Hilton; Hayley A Hutchings; Aida U Jawhari; Mirella Longo; John Mansfield; Jayne M Morgan; Frances Rapport; Anne C Seagrove; Shaji Sebastian; Ian Shaw; Simon P L Travis; Alan Watkins Journal: Lancet Gastroenterol Hepatol Date: 2016-09
Authors: Martin Geoffrey Thomas; Carrie Bayliss; Simon Bond; Francis Dowling; James Galea; Vipul Jairath; Christopher Lamb; Christopher Probert; Elizabeth Timperley-Preece; Alastair Watson; Lynne Whitehead; John G Williams; Miles Parkes; Arthur Kaser; Tim Raine Journal: BMJ Open Date: 2019-02-15 Impact factor: 2.692
Authors: N T Ventham; N A Kennedy; A Duffy; D N Clark; A M Crowe; A D Knight; R J Nicholls; J Satsangi Journal: Aliment Pharmacol Ther Date: 2014-04-20 Impact factor: 8.171