Skip to main content Accessibility help
×
Home

Management for severe Crohn's disease: A lifetime cost-utility analysis

  • Isabelle Jaisson-Hot (a1), Bernard Flourié (a2), Louis Descos (a2) and Cyrille Colin (a1)

Abstract

Objectives: Infliximab is a costly therapy for active Crohn's disease resistant to corticosteroids and immunosuppressive medication. The purpose of this study was to examine whether a treatment including infliximab (episodic re-infusions for relapse or maintenance therapy every 8 weeks) was relevant compared with conventional management (surgery and medical treatment without infliximab) for nonfistulizing resistant Crohn's disease.

Methods: We performed a life-time cost-utility analysis with an analytic Markov decision model from the perspective of the third-party payer system. Utility measurement using Standard Gamble was used to adjust the survival time for each health state of the disease. Direct costs were estimated from standard management based on expert opinion. A sensitivity analysis was conducted to gauge the effects of uncertainty in the values assigned to variables.

Results: The incremental effectiveness with infliximab therapy is .761 Quality-Adjusted Life Years (QALYs) for an added cost ranging from 48,478.79 euros to 596,990.35 euros, depending on treatment procedure. The incremental cost utility ratio expressed in euros per QALYs saved varied from 63,700.82 euros (episodic re-infusions) to over 762,245.09 euros (maintenance therapy).

Conclusions: Infliximab therapy could be cost-effective in the case of relapse treatment only, whereas the marginal cost-utility ratio exceeds conventional benchmarks for maintenance therapy. This analysis will be supplemented by conducting further randomized controlled trials and prospective observational study, focused on the costs of illness (direct and indirect), patient preferences, the disease's clinical course, and infliximab safety.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Management for severe Crohn's disease: A lifetime cost-utility analysis
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Management for severe Crohn's disease: A lifetime cost-utility analysis
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Management for severe Crohn's disease: A lifetime cost-utility analysis
      Available formats
      ×

Copyright

References

Hide All
Arseneau KO, Cohn SM, Cominelli F, Connors AF. 2001 Cost-utility of initial medical management for Crohn's disease perianal fistulae. Gastroenterology. 120: 16401656.
Beck RJ, Pauker SG. 1983 The Markov process in medical prognosis. Med Decis Making. 3: 419458.
BlomqVist P, Ekbom A. 1997 Inflammatory bowel diseases: Health care and costs in Sweden in 1994. Scand J Gastroenterol. 32: 11341139.
Casellas F, Lopez-Vivancos J, Badia X, Vilaesca J, Malagelada JR. 2000 Impact of surgery for Crohn's disease on health-related quality of life. Am J Gastroenterol. 95: 177182.
Colin C. 1995 Les analyses de décision. In: Landrivon G, Delahaye F, editors. La recherche clinique. Paris: Masson
Drossman DA, Patrick DL, Mitchell CM, Zagami EA, Appelbaum MI. 1989 Health-related quality of life in inflammatory bowel disease. Functional status and patient worries and concerns. Dig Dis Sci. 34: 13791386.
Drummond M, O'Brien B, Stoddart G, Torrance G. 1998 Méthodes d'évaluation économique des programmes de santé. 2nd ed. Edts Economica
Fasth S, Helberg R, Hulten L, Magnusson O. 1980 Early complications after surgical treatment for Crohn's disease with particular reference for factors affecting their development. Acta Chir Scand. 146: 519526.
Gregor JC, McDonald JWD, Klar N, et al. 1997 An evaluation of utility measurement in Crohn's disease. Inflamm Bowel Dis. 3: 265276.
Garrett JW, Drossman DA. 1990 Health status in inflammatory bowel disease. Biological and behavioral considerations. Gastroenterology. 99: 9098.
Hanauer SB. 2001 Maintenance infliximab (Remicade) is safe, effective and steroid-sparing in Crohn's disease: Preliminary results from the Accent I trial. Digestive Disease Week (Atlanta)
Heimann TM, Greenstein AJ, Mechanic L, Aufses AH. 1985 Early complications following surgical treatment for Crohn's disease. Ann Surg. 201: 494498.
Hurst RD, Molinari M, Chung TP, Rubin M, Michelassi F. 1997 Prospective study of the features, indications, and surgical treatment in 513 consecutive patients affected by Crohn's disease. Surgery. 122: 661668.
Launois R, Croutsche JJ, Megnigbeto AC, Le Lay K, Portafax C. 1999 L'apport indispensable de l'épidémiologie clinique aux modèles de Markov. JEM. 17: 343361.
Le Gales C, Triomphe A. 1991 L'évaluation économique des interventions en santé publique: Principes et limites. Rev Epidém et santé Publ. 39: 1529.
Love JR, Irvine EJ, Fedorak RN. Quality of life in inflammatory bowel disease. J Clin Gastroenterol. 1992 14: 1519.
Mekhjian HS, Switz DM, Watts HD, et al. National Cooperative Crohn's Disease Study: Factors determining recurrence of Crohn's disease after surgery. Gastroenterology. 1979 77: 907913.
Mekhjian HS, Switz DM, Melnyck CS, Rankin GB, Brooks RK. Clinical features and natural history of Crohn's disease. Gastroenterology. 1979 77: 898906.
Messori A, Brignola C, Trallori G, et al. 1994 Effectiveness of 5-Aminosalicylic Acid for maintaining remission in patients with Crohn's disease: A meta-analysis. Am J Gastroenterol. 89: 692698.
Munkholm P, Langholz E, Davidsen M, Binder V. 1993 Intestinal cancer risk and mortality in patients with Crohn's disease. Gastroenterolgy. 105: 17161723.
O'Donoghue DP, Dawson AM, Powell-Tuck, Bown RL, Lennard-Jones JE. 1978 Doubleblind withdrawal trial of Azathioprine as maintenance treatment for Crohn's disease. Lancet. 2: 955957.
Present DH, Rutgeerts P, Targan, et al. 1999 Infliximab for the treatment of fistulas in patients with Crohn's disease. N Engl J Med. 340: 13981405.
Silverstein MD, Loftus EV, Sandborn WJ, et al. 1999 Clinical course and costs of care for Crohn's disease: Markov model analysis of a population-based cohort. Gastroenterology. 117: 4957.
Targan SR, Hanauer SB, Van Deventer SJH, et al. 1997 A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor α for Crohn's disease. N Engl J Med. 337: 10291035.
Tillinger W, Mittermaier C, Lochs H, Moser G. 1999 Health-related quality of life in patients with Crohn's disease. Influence of surgical operation—A prospective trial. Dig Dis Sci. 44: 932938.
Torrance GW. 1986 Measurement of health-state utilities for economic appraisal: A review. J Health Econ. 5: 130.
Whelan G, Farmer RG, Fazio VW, Goormastic M. 1985 Recurrence after surgery in Crohn's disease. Relationship to location of disease (Clinical pattern) and surgical indication. Gastroenterology. 88: 18261833.
Wong JB, Loftus EV, Feagan BG. 1999 Estimating the cost-effectiveness of Infliximab for Crohn's disease. Gastroenterology. 116: A399A400.
Wright JC, Weinstein MC. Gains in life expectancy from medical interventions—Standardizing data on outcomes. N Engl J Med. 1998 339: 380386.

Keywords

Management for severe Crohn's disease: A lifetime cost-utility analysis

  • Isabelle Jaisson-Hot (a1), Bernard Flourié (a2), Louis Descos (a2) and Cyrille Colin (a1)

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed