Open AccessComparative cost‐effectiveness of strategies to prevent postoperative clinical recurrence of Crohn's disease
Author(s) -
Doherty Glen A.,
Miksad Rebecca A.,
Cheifetz Adam S.,
Moss Alan C.
Publication year - 2012
Publication title -
inflammatory bowel diseases
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.932
H-Index - 146
eISSN - 1536-4844
pISSN - 1078-0998
DOI - 10.1002/ibd.21904
Subject(s) - medicine , crohn's disease , discontinuation , azathioprine , infliximab , adverse effect , quality adjusted life year , surgery , clinical trial , cost effectiveness , randomized controlled trial , incremental cost effectiveness ratio , disease , risk analysis (engineering)
Background: A number of treatments have been shown to reduce the risk of postoperative recurrence of Crohn's disease (CD). The optimal strategy is unknown. The aim was to evaluate the comparative cost‐effectiveness of postoperative strategies to prevent clinical recurrence of CD. Methods: Three prophylactic strategies were compared to “no prophylaxis”; mesalamine, azathioprine (AZA) / 6‐mercaptopurine (6‐MP), and infliximab. The probability of clinical recurrence, endoscopic recurrence, and therapy discontinuation due to adverse drug reactions (ADRs) were extracted from randomized controlled trials (RCTs). Quality‐of‐life scores and treatment costs were derived from published data. The primary model evaluated quality‐adjusted life years (QALYs) and cost‐effectiveness at 1 year after surgery. Sensitivity analysis assessed the impact of a range of recurrence rates on cost‐effectiveness. An exploratory analysis evaluated cost‐effectiveness outcomes 5 years after surgery. Results: A strategy of “no prophylaxis” was the least expensive one at 1 and 5 years after surgery. Compared to this approach, AZA/6‐MP had the most favorable incremental cost‐effectiveness ratio (ICER) ($299,188/QALY gained), and yielded the highest net health benefits of the medication strategies at 1 year. Sensitivity analysis determined that the ICER of AZA/6‐MP was preferable to mesalamine up to a recurrence rate of 52%, but mesalamine dominated at higher rates. In the 5‐year exploratory analysis, mesalamine had the most favorable ICER over 5 years ($244,177/QALY gained). Conclusions: Compared to no prophylactic treatment, AZA/6‐MP has the most favorable ICER in the prevention of clinical recurrence of postoperative CD up to 1 year. At 5 years, mesalamine had the most favorable ICER in this model. (Inflamm Bowel Dis 2012;)