Parambir S Dulai1, Vipul Jairath2, Neeraj Narula3, Emily Wong3, Gursimran S Kochhar4, Jean-Frederic Colombel5, William J Sandborn1. 1. Division of Gastroenterology, University of California San Diego, La Jolla, California, USA. 2. Division of Gastroenterology, Western University, London, Ontario, Canada. 3. Division of Gastroenterology, Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton Ontario, Canada. 4. Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, Pennsylvania, USA. 5. Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Abstract
INTRODUCTION: Cost-effectiveness of biomarker- vs endoscopy-based treat-to-target monitoring in Crohn's disease (CD) is unknown. METHODS: A microsimulation model for CD was built to simulate biomarker (fecal calprotectin) vs endoscopy-based monitoring in a treat-to-target fashion. Published literature in combination with patient-level data from phase 3 clinical trials and population estimates for therapeutic drug monitoring were used to generate transition probabilities, costs, and utilities. Tracker variables were used to modify downstream probabilities and outcomes based on previous exposures, response patterns, and disease-related complications or surgery history. The primary outcome was cost-effectiveness over a 5-year horizon at a willingness-to-pay threshold of $100,000/quality-adjusted life-year. Probabilistic sensitivity analyses in addition to multiple 1-, 2-, and 3-way microsimulation sensitivity analyses were performed. RESULTS: In the base-case model, the endoscopy-based monitoring strategy dominated the biomarker-based monitoring strategy over a 5-year horizon. Over shorter periods of observation, the biomarker-based monitoring strategy became progressively more cost-effective, with cost-effectiveness achieved for this strategy over a 1-year horizon. Therapeutic drug monitoring did not influence short-term cost-effectiveness of biomarker-based monitoring. Once in endoscopic remission, continued biomarker-based vs endoscopy-based monitoring was more cost-effective. A hybrid biomarker-endoscopy-based monitoring strategy dominated the endoscopy-based monitoring strategy over a 5-year horizon. The strongest determinants for cost-effectiveness were cost of colonoscopy and diagnostic performance of fecal calprotectin. DISCUSSION: The most cost-effective approach for treat-to-target monitoring in CD is up-front biomarker-based monitoring followed by endoscopy-based monitoring if not in endoscopic remission by 1 year and then returning to biomarker-based monitoring once in endoscopic remission.
INTRODUCTION: Cost-effectiveness of biomarker- vs endoscopy-based treat-to-target monitoring in Crohn's disease (CD) is unknown. METHODS: A microsimulation model for CD was built to simulate biomarker (fecal calprotectin) vs endoscopy-based monitoring in a treat-to-target fashion. Published literature in combination with patient-level data from phase 3 clinical trials and population estimates for therapeutic drug monitoring were used to generate transition probabilities, costs, and utilities. Tracker variables were used to modify downstream probabilities and outcomes based on previous exposures, response patterns, and disease-related complications or surgery history. The primary outcome was cost-effectiveness over a 5-year horizon at a willingness-to-pay threshold of $100,000/quality-adjusted life-year. Probabilistic sensitivity analyses in addition to multiple 1-, 2-, and 3-way microsimulation sensitivity analyses were performed. RESULTS: In the base-case model, the endoscopy-based monitoring strategy dominated the biomarker-based monitoring strategy over a 5-year horizon. Over shorter periods of observation, the biomarker-based monitoring strategy became progressively more cost-effective, with cost-effectiveness achieved for this strategy over a 1-year horizon. Therapeutic drug monitoring did not influence short-term cost-effectiveness of biomarker-based monitoring. Once in endoscopic remission, continued biomarker-based vs endoscopy-based monitoring was more cost-effective. A hybrid biomarker-endoscopy-based monitoring strategy dominated the endoscopy-based monitoring strategy over a 5-year horizon. The strongest determinants for cost-effectiveness were cost of colonoscopy and diagnostic performance of fecal calprotectin. DISCUSSION: The most cost-effective approach for treat-to-target monitoring in CD is up-front biomarker-based monitoring followed by endoscopy-based monitoring if not in endoscopic remission by 1 year and then returning to biomarker-based monitoring once in endoscopic remission.
Authors: E Joline de Groof; Toer W Stevens; Willem A Bemelman; Cyriel Y Ponsioen; Emma J Eshuis; Tjibbe J Gardenbroek; Judith E Bosmans; J M van Dongen; Bregje Mol; Christianne J Buskens; Pieter C F Stokkers; Ailsa Hart; Geert R D'Haens Journal: Gut Date: 2019-02-01 Impact factor: 23.059
Authors: Johan Burisch; Gediminas Kiudelis; Limas Kupcinskas; Hendrika Adriana Linda Kievit; Karina Winther Andersen; Vibeke Andersen; Riina Salupere; Natalia Pedersen; Jens Kjeldsen; Renata D'Incà; Daniela Valpiani; Doron Schwartz; Selwyn Odes; Jóngerð Olsen; Kári Rubek Nielsen; Zsuzsanna Vegh; Peter Laszlo Lakatos; Alina Toca; Svetlana Turcan; Konstantinos H Katsanos; Dimitrios K Christodoulou; Mathurin Fumery; Corinne Gower-Rousseau; Stefania Chetcuti Zammit; Pierre Ellul; Carl Eriksson; Jonas Halfvarson; Fernando Jose Magro; Dana Duricova; Martin Bortlik; Alberto Fernandez; Vicent Hernández; Sally Myers; Shaji Sebastian; Pia Oksanen; Pekka Collin; Adrian Goldis; Ravi Misra; Naila Arebi; Ioannis P Kaimakliotis; Inna Nikuina; Elena Belousova; Marko Brinar; Silvija Cukovic-Cavka; Ebbe Langholz; Pia Munkholm Journal: Gut Date: 2018-01-23 Impact factor: 23.059
Authors: James D Lewis; Paul Rutgeerts; Brian G Feagan; Geert D'haens; Silvio Danese; Jean-Frederic Colombel; Walter Reinisch; David T Rubin; Christian Selinger; Meenakshi Bewtra; Lisa Barcomb; Ana P Lacerda; Kori Wallace; James W Butler; Meijing Wu; Qian Zhou; Xiaomei Liao; William J Sandborn Journal: Inflamm Bowel Dis Date: 2019-10-23 Impact factor: 5.325
Authors: Paul Rutgeerts; Christopher Gasink; Daphne Chan; Yinghua Lang; Paul Pollack; Jean-Frederic Colombel; Douglas C Wolf; Douglas Jacobstein; Jewel Johanns; Philippe Szapary; Omoniyi J Adedokun; Brian G Feagan; William J Sandborn Journal: Gastroenterology Date: 2018-08-29 Impact factor: 22.682
Authors: Laurent Peyrin-Biroulet; W Scott Harmsen; William J Tremaine; Alan R Zinsmeister; William J Sandborn; Edward V Loftus Journal: Am J Gastroenterol Date: 2012-09-04 Impact factor: 10.864
Authors: Laurent Peyrin-Biroulet; Walter Reinisch; Jean-Frederic Colombel; Gerassimos J Mantzaris; Asher Kornbluth; Robert Diamond; Paul Rutgeerts; Linda K Tang; Freddy J Cornillie; William J Sandborn Journal: Gut Date: 2013-08-23 Impact factor: 23.059