Tight control for Crohn's disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial
<p><strong>Objective</strong> To evaluate the cost-effectiveness of an inflammatory biomarker and clinical symptom directed tight control strategy (TC) compared with symptom-based clinical management (CM) in patients with Crohn’s disease (CD) naïve to immunosuppressants and biologi...
| Main Authors: | , , , , , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
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BMJ Publishing Group
2019
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| _version_ | 1797050965593948160 |
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| author | Panaccione, R Colombel, J Travis, S Bossuyt, P Baert, F Vaňásek, T Danalıoğlu, A Novacek, G Armuzzi, A Reinisch, W Johnson, S Buessing, M Neimark, E Petersson, J Lee, W D'Haens, G |
| author_facet | Panaccione, R Colombel, J Travis, S Bossuyt, P Baert, F Vaňásek, T Danalıoğlu, A Novacek, G Armuzzi, A Reinisch, W Johnson, S Buessing, M Neimark, E Petersson, J Lee, W D'Haens, G |
| author_sort | Panaccione, R |
| collection | OXFORD |
| description | <p><strong>Objective</strong> To evaluate the cost-effectiveness of an inflammatory biomarker and clinical symptom directed tight control strategy (TC) compared with symptom-based clinical management (CM) in patients with Crohn’s disease (CD) naïve to immunosuppressants and biologics using a UK public payer perspective.</p> <p><strong>Design</strong> A regression model estimated weekly CD Activity Index (CDAI)-based transition matrices (remission: CDAI <150, moderate: CDAI ≥150 to <300, severe: CDAI ≥300 to <450, very severe: CDAI ≥450) based on the Effect of Tight Control Management on Crohn’s Disease (CALM) trial. A regression predicted hospitalisations. Health utilities and costs were applied to health states. Work productivity was monetised and included in sensitivity analyses. Remission rate, CD-related hospitalisations, adalimumab injections, other direct medical costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated.</p> <p><strong>Results</strong> Over 48 weeks, TC was associated with a higher clinical remission (CDAI <150) rate (58.2% vs 46.8%), fewer CD-related hospitalisations (0.124 vs 0.297 events per patient) and more injections of adalimumab (40 mg sc) (mean 31.0 vs 24.7) than CM. TC was associated with 0.032 higher QALYs and £593 higher total medical costs. The ICER was £18 656 per QALY. The ICER was cost-effective in 57.9% of simulations. TC became dominant, meaning less costly but more effective, when work productivity was included.</p> <p><strong>Conclusion</strong> A TC strategy as used in the CALM trial is cost-effective compared with CM. Incorporating costs related to work productivity increases the economic value of TC. Cross-national inferences from this analysis should be made with caution given differences in healthcare systems.</p> <p><strong>Trial registration number</strong> NCT01235689.</p> |
| first_indexed | 2024-03-06T18:13:02Z |
| format | Journal article |
| id | oxford-uuid:03ab2042-b70f-4e25-8240-bfc35e965c52 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-06T18:13:02Z |
| publishDate | 2019 |
| publisher | BMJ Publishing Group |
| record_format | dspace |
| spelling | oxford-uuid:03ab2042-b70f-4e25-8240-bfc35e965c522022-03-26T08:47:36ZTight control for Crohn's disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trialJournal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:03ab2042-b70f-4e25-8240-bfc35e965c52EnglishSymplectic Elements at OxfordBMJ Publishing Group2019Panaccione, RColombel, JTravis, SBossuyt, PBaert, FVaňásek, TDanalıoğlu, ANovacek, GArmuzzi, AReinisch, WJohnson, SBuessing, MNeimark, EPetersson, JLee, WD'Haens, G<p><strong>Objective</strong> To evaluate the cost-effectiveness of an inflammatory biomarker and clinical symptom directed tight control strategy (TC) compared with symptom-based clinical management (CM) in patients with Crohn’s disease (CD) naïve to immunosuppressants and biologics using a UK public payer perspective.</p> <p><strong>Design</strong> A regression model estimated weekly CD Activity Index (CDAI)-based transition matrices (remission: CDAI <150, moderate: CDAI ≥150 to <300, severe: CDAI ≥300 to <450, very severe: CDAI ≥450) based on the Effect of Tight Control Management on Crohn’s Disease (CALM) trial. A regression predicted hospitalisations. Health utilities and costs were applied to health states. Work productivity was monetised and included in sensitivity analyses. Remission rate, CD-related hospitalisations, adalimumab injections, other direct medical costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated.</p> <p><strong>Results</strong> Over 48 weeks, TC was associated with a higher clinical remission (CDAI <150) rate (58.2% vs 46.8%), fewer CD-related hospitalisations (0.124 vs 0.297 events per patient) and more injections of adalimumab (40 mg sc) (mean 31.0 vs 24.7) than CM. TC was associated with 0.032 higher QALYs and £593 higher total medical costs. The ICER was £18 656 per QALY. The ICER was cost-effective in 57.9% of simulations. TC became dominant, meaning less costly but more effective, when work productivity was included.</p> <p><strong>Conclusion</strong> A TC strategy as used in the CALM trial is cost-effective compared with CM. Incorporating costs related to work productivity increases the economic value of TC. Cross-national inferences from this analysis should be made with caution given differences in healthcare systems.</p> <p><strong>Trial registration number</strong> NCT01235689.</p> |
| spellingShingle | Panaccione, R Colombel, J Travis, S Bossuyt, P Baert, F Vaňásek, T Danalıoğlu, A Novacek, G Armuzzi, A Reinisch, W Johnson, S Buessing, M Neimark, E Petersson, J Lee, W D'Haens, G Tight control for Crohn's disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial |
| title | Tight control for Crohn's disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial |
| title_full | Tight control for Crohn's disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial |
| title_fullStr | Tight control for Crohn's disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial |
| title_full_unstemmed | Tight control for Crohn's disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial |
| title_short | Tight control for Crohn's disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial |
| title_sort | tight control for crohn s disease with adalimumab based treatment is cost effective an economic assessment of the calm trial |
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