Tight control for Crohn's disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial / R. Panaccione, JF. Colombel, SPL. Travis, P. Bossuyt, F. Baert, T. Vaňásek, A. Danalıoğlu, G. Novacek, A. Armuzzi, W. Reinisch, S. Johnson, M. Buessing, E. Neimark, J. Petersson, WJ. Lee, GR. D'Haens,
Panaccione, Remo Inflammatory Bowel Disease Unit, University of Calgary, Calgary, Alberta, Canada. Colombel, Jean-Frederic Division of Gastroenterology, Icahn School of Medicine Vanasek, Division of Gastroenterology and Hepatology, New York, New York, USA. Travis, Simon P L Gastroenterology, John Radcliffe Hospital, Oxford, UK. Bossuyt, Peter Gastroenterology, Imelda General Hospital, Bonheiden, Belgium. Baert, Filip Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium. Vaňásek, Tomáš Division of Gastroenterology and Hepatology, Hepato-Gastroenterologie HK, sro, Hradec Králové, Czech Republic. Danalioglu, Ahmet Gastroenterology Department, Bezmialem Vakıf University, Istanbul, Turkey. Novacek, Gottfried Department of Internal Medicine IV, Medical University of Vienna, Vienna, Austria. Armuzzi, Alessandro Internal Medicine and Gastroenterology, Catholic University, Rome, Italy. Reinisch, Walter Department of Medicine IV, Medical University Vienna, Vienna, Austria. Johnson, Scott Medicus Economics LCC., Milton, Maine, USA. Buessing, Marric Medicus Economics, Boston, Massachusetts, USA. Neimark, Ezequiel AbbVie Inc., North Chicago, Illinois, USA. Petersson, Joel AbbVie Inc., North Chicago, Illinois, USA. Lee, Wan-Ju AbbVie Inc., North Chicago, Illinois, USA. D'Haens, Geert R Gastroenterology, AMC, Amsterdam, The Netherlands.
Gut. 2020, roč. 69, č. 4, s. 658-664. ISSN: 0017-5749; 1468-3288 (elektronická verze).
OBJECTIVE: To evaluate the cost-effectiveness of an inflammatory biomarker and clinical symptom directed tight control strategy (TC) compared with symptom-based clinical management (CM) in patients with Crohn's disease (CD) naïve to immunosuppressants and biologics using a UK public payer perspective. DESIGN: A regression model estimated weekly CD Activity Index (CDAI)-based transition matrices (remission: CDAI <150, moderate: CDAI ≥150 to <300, severe: CDAI ≥300 to <450, very severe: CDAI ≥450) based on the Effect of Tight Control Management on Crohn's Disease (CALM) trial. A regression predicted hospitalisations. Health utilities and costs were applied to health states. Work productivity was monetised and included in sensitivity analyses. Remission rate, CD-related hospitalisations, adalimumab injections, other direct medical costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated. RESULTS: Over 48 weeks, TC was associated with a higher clinical remission (CDAI <150) rate (58.2% vs 46.8%), fewer CD-related hospitalisations (0.124 vs 0.297 events per patient) and more injections of adalimumab (40 mg sc) (mean 31.0 vs 24.7) than CM. TC was associated with 0.032 higher QALYs and £593 higher total medical costs. The ICER was £18 656 per QALY. The ICER was cost-effective in 57.9% of simulations. TC became dominant, meaning less costly but more effective, when work productivity was included. CONCLUSION: A TC strategy as used in the CALM trial is cost-effective compared with CM. Incorporating costs related to work productivity increases the economic value of TC. Cross-national inferences from this analysis should be made with caution given differences in healthcare systems. TRIAL REGISTRATION NUMBER: NCT01235689; Results.