A Microsimulation Model to Determine the Cost-Effectiveness of Treat-to-Target Strategies for Crohn's Disease.
A Microsimulation Model to Determine the Cost-Effectiveness of Treat-to-Target Strategies for Crohn's Disease.
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DOI：
10.14309/ajg.0000000000001263
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发表时间：
2021-08-01
期刊：
影响因子：
--
通讯作者：
Sandborn WJ
中科院分区：
文献类型：
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作者：
Dulai PS;Jairath V;Narula N;Wong E;Kochhar GS;Colombel JF;Sandborn WJ
Cost-effectiveness of biomarker- versus endoscopy-based treat-to-target monitoring in Crohn’s disease (CD) is unknown. A microsimulation model for CD was built to simulate biomarker (fecal calprotectin) versus 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 prior 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 (QALY). Probabilistic sensitivity analyses in addition to multiple 1-, 2-, and 3-way microsimulation sensitivity analyses were performed. In the base-case model, the endoscopy-base 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 versus 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. 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.
