Comparative cost-effectiveness of strategies to prevent postoperative clinical recurrence of Crohn's disease

被引:31
作者
Doherty, Glen A. [2 ]
Miksad, Rebecca A. [3 ,4 ]
Cheifetz, Adam S. [2 ]
Moss, Alan C. [1 ,2 ]
机构
[1] Harvard Univ, Sch Med, Div Gastroenterol, Beth Israel Deaconess Med Ctr, Boston, MA 02215 USA
[2] Beth Israel Deaconess Med Ctr, Ctr Inflammatory Bowel Dis, Boston, MA 02215 USA
[3] Beth Israel Deaconess Med Ctr, Div Hematol & Oncol, Boston, MA 02215 USA
[4] MGH Inst Technol Assessment, Boston, MA USA
关键词
Crohn's disease; prophylaxis; decision analysis; cost-effectiveness; MAINTENANCE THERAPY; RISK-FACTORS; INFLIXIMAB; SURGERY; PROPHYLAXIS; RECOMMENDATIONS; AZATHIOPRINE; ADALIMUMAB;
D O I
10.1002/ibd.21904
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
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;)
引用
收藏
页码:1608 / 1616
页数:9
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