Infliximab dose escalation vs. initiation of adalimumab for loss of response in Crohn's disease: a cost-effectiveness analysis
Infliximab dose escalation vs. initiation of adalimumab for loss of response in Crohn's disease: a cost-effectiveness analysis
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DOI：
10.1111/j.1365-2036.2007.03548.x
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发表时间：
2007-12-01
影响因子：
7.6
通讯作者：
Sands, B. E.
中科院分区：
文献类型：
--
作者：
Kaplan, G. G.;Hur, C.;Sands, B. E.
背景：对5 mg/kg英夫利昔单抗失去反应的克罗恩病患者可以通过将英夫利昔单抗的剂量增加到10 mg/kg来恢复反应。另外，阿达木单抗也可用作抢救治疗。目的：在使用5 mg/kg英夫利昔单抗失去反应后，与阿达木单抗相比，英夫利昔单抗剂量递增是否具有成本效益。方法决策分析模型模拟了两组克罗恩病患者：(i)英夫利昔单抗剂量增加到10 mg/kg； （ii）停用英夫利昔单抗，患者开始使用阿达木单抗。时间范围是1年。进行单、双向敏感性分析。与阿达木单抗策略（0.76）相比，英夫利昔单抗剂量递增策略产生了更多的质量调整生命年（0.79）。增量成本效益比为332 032美元/质量调整生命年。敏感性分析表明，模型结果是稳健的。最重要的变量是英夫利昔单抗和阿达木单抗的成本，因此英夫利昔单抗成本降低1/3导致成本-效果比增量低于80,000美元/质量调整生命年。结论：在克罗恩病患者对5 mg/kg英夫利昔单抗失去反应后，与改用阿达唑单抗相比，剂量增加将产生更多的质量调整生命年；然而，成本是相当可观的。
BackgroundCrohn's disease patients who have lost response to 5 mg/kg of infliximab may regain response by increasing the dose of infliximab to 10 mg/kg. Alternatively, adalimumab can be used as a rescue therapy.AimTo determine whether dose escalation of infliximab was a cost-effective strategy compared with adalimumab initiation after loss of response to 5 mg/kg of infliximab.MethodsA decision-analysis model simulated two cohorts of Crohn's patients: (i) infliximab dose was escalated to 10 mg/kg and (ii) infliximab was discontinued and patients were started on adalimumab. The time horizon was 1 year. One-and two-way sensitivity analyses were performed. Results The infliximab dose escalation strategy yielded more quality-adjusted life years (0.79) compared with the adalimumab strategy (0.76). The incremental cost-effectiveness ratio was $332 032/quality-adjusted life year. Sensitivity analysis demonstrated that the model findings were robust. The most significant variables were the cost of infliximab and that of adalimumab, such that a reduction in the cost of infliximab by 1/3 resulted in an incremental cost-effectiveness ratio below $80 000/quality-adjusted life year.ConclusionAfter a Crohn's patient has lost response to 5 mg/kg of infliximab, dose escalation will yield more quality-adjusted life-year compared with switching to adaliumamb; however, the cost was considerable.