A systematic review of cost-effectiveness studies comparing conventional, biological and surgical interventions for inflammatory bowel disease.
A systematic review of cost-effectiveness studies comparing conventional, biological and surgical interventions for inflammatory bowel disease.
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DOI：
10.1371/journal.pone.0185500
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Pittet V
中科院分区：
文献类型：
--
作者：
Pillai N;Dusheiko M;Burnand B;Pittet V
炎症性肠病（IBD）是一种慢性疾病，给全球卫生系统带来了巨大的健康和经济负担。治疗前景是复杂的，有多种策略来诱导和维持缓解，同时避免长期并发症。需要评估由于昂贵的生物制剂而增加的治疗费用在多大程度上被改善的结果和更少的住院和手术所抵消。本系统综述旨在评估IBD治疗策略的成本效益。2017年3月进行了系统的文献检索，以确定对诊断为克罗恩病（CD）或溃疡性结肠炎（UC）的成人进行药物和手术干预的经济评估。成本和增量成本效益比（ICERs）进行了调整，以反映2015年购买力平价（PPP）。偏倚风险评估和个别研究结果的叙述综合提出。纳入49篇文章；CD上24张，UC上25张。与中度或重度CD患者的标准治疗相比，英夫利昔单抗和阿达木单抗诱导和维持治疗具有成本效益；然而，在常规药物难治性CD患者中，瘘管CD和维持手术诱导缓解的ICERs高于可接受的成本-效果阈值。在轻度UC中，与标准剂量相比，使用高剂量美沙拉嗪诱导缓解占主导地位。在常规治疗难治性UC中，与标准治疗相比，英夫利昔单抗和阿达木单抗诱导和维持治疗不具有成本效益；然而，使用维多单抗和手术治疗的ICERs是有利的。我们发现，一般来说，虽然生物制剂有助于改善预后，但它们的成本很高，因此不具有成本效益，特别是用于维持治疗。随着市场价格的下降和生物仿制药的引入，生物制剂的成本效益可能会提高。未来的研究应确定反映常规临床实践的最佳治疗策略，纳入间接成本并评估终身成本和收益。
Inflammatory bowel disease (IBD) is a chronic disease placing a large health and economic burden on health systems worldwide. The treatment landscape is complex with multiple strategies to induce and maintain remission while avoiding long-term complications. The extent to which rising treatment costs, due to expensive biologic agents, are offset by improved outcomes and fewer hospitalisations and surgeries needs to be evaluated. This systematic review aimed to assess the cost-effectiveness of treatment strategies for IBD. A systematic literature search was performed in March 2017 to identify economic evaluations of pharmacological and surgical interventions, for adults diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC). Costs and incremental cost-effectiveness ratios (ICERs) were adjusted to reflect 2015 purchasing power parity (PPP). Risk of bias assessments and a narrative synthesis of individual study findings are presented. Forty-nine articles were included; 24 on CD and 25 on UC. Infliximab and adalimumab induction and maintenance treatments were cost-effective compared to standard care in patients with moderate or severe CD; however, in patients with conventional-drug refractory CD, fistulising CD and for maintenance of surgically-induced remission ICERs were above acceptable cost-effectiveness thresholds. In mild UC, induction of remission using high dose mesalazine was dominant compared to standard dose. In UC refractory to conventional treatments, infliximab and adalimumab induction and maintenance treatment were not cost-effective compared to standard care; however, ICERs for treatment with vedolizumab and surgery were favourable. We found that, in general, while biologic agents helped improve outcomes, they incurred high costs and therefore were not cost-effective, particularly for use as maintenance therapy. The cost-effectiveness of biologic agents may improve as market prices fall and with the introduction of biosimilars. Future research should identify optimal treatment strategies reflecting routine clinical practice, incorporate indirect costs and evaluate lifetime costs and benefits.
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2.7
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