Canadian cost-utility analysis of initiation and maintenance treatment with anti-TNF-α drugs for refractory Crohn's disease
Canadian cost-utility analysis of initiation and maintenance treatment with anti-TNF-α drugs for refractory Crohn's disease
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DOI：
10.1016/j.crohns.2011.07.007
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发表时间：
2012-02-01
影响因子：
8
通讯作者：
Goeree, Ron
中科院分区：
文献类型：
--
作者：
Blackhouse, Gord;Assasi, Nazila;Goeree, Ron
目的：克罗恩病（CD）是一种慢性胃肠道炎症性疾病。症状包括但不限于腹痛、恶心、呕吐和腹泻。抗INF-α药物越来越多地用于对常规治疗反应不足的CD患者。然而，这些药物相当昂贵。本研究的目的是评估两种抗TNF-α药物（英夫利西单抗，阿达木单抗）治疗难治性CD的成本效用。方法：采用马尔可夫模型估计5年时间范围内三种治疗（常规治疗，英夫利西单抗，阿达木单抗）的成本和Q值。初始治疗后，患者达到缓解、达到治疗反应或保持药物难治性健康状态。达到缓解或治疗反应的患者在每个3个月模型周期中有复发的风险。处于药物难治性健康状态的患者要么保持健康状态，要么在每个周期进行手术。不同的成本和效用值被分配给不同的模型健康状态。模型输入参数包括初始应答率、复发率、效用值均来自已发表的文献。结果：泌尿系统治疗的预期成本最低（17，017美元），Q值最低（2.555），而英夫利西单抗的预期成本最高（54，084美元），Q值最高（2.721）。每QALY的增量成本从日常护理阿达木单抗和阿达木单抗英夫利昔单抗移动估计分别为$193，305和$451，165，respectively.Conclusions：基于共同的支付意愿阈值，抗INF-α药物不会被视为一种具有成本效益的治疗难治性CD。(C)2011年欧洲克罗恩病和结肠炎组织。Elsevier B. V.出版，保留所有权利。
Objectives: Crohn's disease (CD) is a chronic inflammatory disease of the gastrointestinal tract. Symptoms include but are not limited to abdominal pain, nausea, emesis, and diarrhea. Anti-INF-alpha drugs are increasingly being used in patients with CD who have inadequate response to conventional therapy. However, these medications are quite expensive. The objective of this study is to evaluate the cost-utility of two anti-TNF-alpha drugs (infliximab, adalimumab) for refractory CD.Methods: A Markov model was used to estimate the costs and QALYs of three treatments (usual care, infliximab, adalimumab) over a 5 year time horizon. After initial treatment, patients achieve remission, achieve treatment response or remain in the drug refractory health state. Patients who achieve remission or treatment response are at risk of relapse each 3 month model cycle. Patients in the drug refractory health state either remain in the health state or have surgery in each cycle. Different costs and utility values were assigned to the various model health states. Model input parameters including initial response rates, relapse rates, utility values were derived from published literature.Results: Usual care had both the lowest expected costs ($17,017) and QALYs (2.555), while infliximab had both the highest expected costs ($54,084) and QALYs (2.721). The incremental cost per QALY moving from usual care to adalimumab and from adalimumab to infliximab was estimated to be to be $193,305 and $451,165, respectively.Conclusions: Based on common willingness to pay thresholds, ant-INF-alpha drugs would not be perceived as a cost effective treatment for refractory CD. (C) 2011 European Crohn's and Colitis Organisation. Published by Elsevier B.V. All rights reserved.