Cost-utility of initial medical management for Crohn's disease perianal fistulae
Cost-utility of initial medical management for Crohn's disease perianal fistulae
复制标题
DOI：
10.1053/gast.2001.24884
复制
发表时间：
2001-06-01
期刊：
影响因子：
29.4
通讯作者：
Connors, AF
中科院分区：
文献类型：
--
作者：
Arseneau, KO;Cohn, SM;Connors, AF
（背景和目标）下栏：英夫利昔单抗的成本效用未知，本研究的目的是确定克罗恩病 (CD) 肛周瘘药物治疗的增量成本效用 (CUinc)，（方法）下栏：使用马尔霍夫模型模拟 1 年治疗期，使用以下药物：6-巯基嘌呤和甲硝唑 [6MP/met]（比较），3英夫利昔单抗输注 + 6MP/met 作为二线治疗（干预 I），英夫利昔单抗间歇性回输（干预 II），以及 6MP/met + 英夫利昔单抗作为二线治疗（干预 III）。通过标准赌博从 CD 患者和健康个体中获得效用，并从医院账单数据中获得成本。通过敏感性分析评估不确定性，（结果）下栏：所有策略均具有相似的有效性。干预措施 I、II 和 III 稍微有效，但也比 6MP/met 更昂贵（干预措施 I：CUinc = 355,450 美元/质量调整生命年 [QALY]；干预措施 II：CUinc = 360,900 美元/QALY；干预 III：CUinc = 377,000 美元/QALY）。如果英夫利昔单抗的成本降低至每次输注 304 美元，则干预 II 的 CUinc 将为 54,050 美元/QALY。 （结论）下栏：根据现有数据，所有策略在我们的模型中都具有相似的有效性，但英夫利昔单抗比 6MP/met 贵得多。英夫利昔单抗在一年内治疗 CD 肛周瘘的增量效益可能无法证明较高的成本是合理的。有必要进行直接比较 6MP/met 和英夫利昔单抗的前瞻性研究。
(Background & Aims) under bar: The cost-utility of infliximab is unknown, The aim of this study was to determine the incremental cost-utility (CUinc) of medical therapy for Crohn's disease (CD) perianal fistula, (Methods) under bar: A Marhov model was used to simulate a 1-year treatment period with the following: 6-mercaptopurine and metronidazole [6MP/met] (comparator), 3 infliximab infusions + 6MP/met as second-line therapy (intervention I), infliximab with episodic reinfusion (intervention II), and 6MP/met + infliximab as second-line therapy (intervention III). Utilities were elicited from patients with CD and healthy individuals by standard gamble, and costs were obtained from hospital billing data. Uncertainty was assessed by sensitivity analysis, (Results) under bar: All strategies had similar effectiveness. Interventions I, II, and III were slightly more effective, but also more costly than 6MP/met (Intervention I: CUinc = $355,450/quality-adjusted life-years [QALY]; Intervention II: CUinc = $360,900/QALY; Intervention III: CUinc = $377,000/QALY). If the cost of infliximab were reduced to $304 per infusion, the CUinc for intervention II would be $54,050/QALY. (Conclusions) under bar: Based on available data, all strategies had similar effectiveness in our model, but infliximab was much more expensive than 6MP/met. The incremental benefit of infliximab for treating CD perianal fistulae over a 1-year period may not justify the higher cost. Prospective studies directly comparing 6MP/met and infliximab are warranted.