Mesenchymal Stem/Stromal Cell Therapy Is More Cost-Effective Than Fecal Diversion for Treatment of Perianal Crohn's Disease Fistulas.
Mesenchymal Stem/Stromal Cell Therapy Is More Cost-Effective Than Fecal Diversion for Treatment of Perianal Crohn's Disease Fistulas.
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DOI：
10.3389/fimmu.2022.859954
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发表时间：
2022
影响因子：
7.3
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中科院分区：
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克罗恩病（CD）是一种炎症性肠病，在全球范围内的发病率和患病率不断增加。肛周瘘见于高达26%的CD患者，并且通常对药物治疗无效。CD肛周瘘（pCD）的当前治疗包括抗生素、生物制剂，对于难治性病例，采用回肠造口术或结肠造口术进行粪便分流（FD）。间充质干细胞/基质细胞疗法（MSC）是一种新的治疗pCD的方法。局部注射到pCD中的MSC可以导致愈合，并且III期临床试验（ADMIRE-CD）显示66%的临床应答，导致MSC（Alofisel，Takeda）在欧盟获得批准。目前还不清楚MSC是否比目前的FD标准更具成本效益。因此，我们开发了一个决策树模型，以确定与FD相比，MSC用于pCD的成本效益。我们的研究表明，在学术医疗中心，自体和同种异体MSC比FD更具成本效益，即使在最坏的情况下，MSC治疗的所有并发症的机会为100%，FD的并发症的机会为0%，同种异体和自体MSC与FD相比仍然节省成本。
Crohn’s disease (CD) is an inflammatory bowel disease with increasing incidence and prevalence worldwide. Perianal fistulas are seen in up to 26% of CD patients and are often refractory to medical therapy. Current treatments for CD perianal fistulas (pCD) include antibiotics, biologics, and for refractory cases, fecal diversion (FD) with ileostomy or colostomy. Mesenchymal stem/stromal cell therapy (MSCs) is a new modality that have shown efficacy in treating pCD. MSCs locally injected into pCD can lead to healing, and a phase III clinical trial (ADMIRE-CD) showed 66% clinical response, leading to approval of MSCs (Alofisel, Takeda) in the European Union. It is unclear if MSCs would be more cost-effective than the current standard of FD. We therefore developed a decision tree model to determine the cost-effectiveness of MSCs compared to FD for pCD. Our study showed that both autologous and allogeneic MSCs are more cost-effective than FD in an academic medical center and even in a worst-case scenario with 100% chance of all complications for MSCs treatment and 0% chance of complications for FD, both allogeneic and autologous MSCs are still cost saving compared to FD.