scholarly journals The Cost-effectiveness of Initial Immunomodulators or Infliximab Using Modern Optimization Strategies for Crohn’s Disease in the Biosimilar Era

2019 ◽  
Author(s):  
Abhinav Vasudevan ◽  
Francis Ip ◽  
Danny Liew ◽  
Daniel R Van Langenberg
Keyword(s):  
Crohn’S Disease ◽  
Cost Effectiveness ◽  
Crohn's Disease ◽  
Combination Therapy ◽  
Cost Effective ◽  
Extended Model ◽  
Life Years ◽  
Cost Effective Treatment ◽  
Therapy Costs ◽  
The Cost

Abstract Background Treatment cost, efficacy, and safety are integral considerations when optimizing management of Crohn’s disease (CD). This study assessed the cost-effectiveness of initial immunomodulator and anti–tumor necrosis factor (anti-TNF) agents for the treatment of CD from a US third-party perspective, incorporating current treatment algorithms, optimization strategies, and reduced costs availed by biosimilars. Method A 1-year Markov model was developed to simulate the cost and quality-adjusted life-years (QALYs) of initial azathioprine, infliximab, and combination therapy for moderate to severe CD. Treatment was changed based on tolerability and clinical disease activity at 3-monthly intervals. Efficacy data were based on published literature. Results Initial azathioprine had the lowest cost and utility ($35,337 and 0.63 QALYs), whereas combination therapy was the costliest yet conferred the highest health benefits ($57,638 and 0.67 QALYs). The incremental cost-effectiveness of infliximab and combination therapy compared with azathioprine were both in excess of $500,000 per QALY gained. Initial azathioprine remained the most cost-effective treatment on sensitivity analysis compared with infliximab and combination therapy, with 90% reductions in anti-TNF therapy costs and a 5-year time horizon, although combination therapy had an acceptable cost-effectiveness when costs were reduced in the extended model. Initial infliximab, ustekinumab, and vedolizumab were dominated by combination therapy. Conclusions In the biosimilar era, initial azathioprine with escalation to infliximab appeared more cost-effective in the short term compared with infliximab or combination therapy, although initial combination therapy yields acceptable ICERs in the long term with continued reductions in anti-TNF therapy costs and will likely be the preferred treatment strategy in the future.

scholarly journals The Cost-effectiveness of Biological Therapy Cycles in the Management of Crohn’s Disease

2019 ◽  
Vol 13 (10) ◽  
pp. 1323-1333 ◽  
Author(s):  
Kristian Bolin ◽  
Erik Hertervig ◽  
Edouard Louis
Keyword(s):  
Crohn’S Disease ◽  
Cost Effectiveness ◽  
Crohn's Disease ◽  
Combination Therapy ◽  
Willingness To Pay ◽  
Cost Effective ◽  
Treatment Intensification ◽  
Tree Model ◽  
Necrosis Factor Alpha ◽  
The Cost

Abstract Objectives To examine the cost-effectiveness of continued treatment for patients with moderate-severe Crohn’s disease in clinical remission, with a combination of anti-tumour necrosis factor alpha [anti-TNFα] [infliximab] and immunomodulator therapy compared with two different withdrawal strategies: [1] withdrawal of the anti-TNFα therapy; and [2] withdrawal of the immunomodulator therapy, respectively. Methods A decision-tree model was constructed mimicking three treatment arms: [1] continued combination therapy with infliximab and immunomodulator; [2] withdrawal of infliximab; or [3] withdrawal of the immunomodulator. Relapses in each arm are managed with treatment intensification and re-institution of the de-escalated drug according to a prespecified algorithm. State-dependent relapse risks, remission probabilities, and quality of life weights were collected from previous published studies. Results Combination therapy was less costly and more efficient than the withdrawal of the immunomodulator, and more costly and more efficient than withdrawal of infliximab. Whether or not combination therapy is cost-effective, compared with the alternatives, depends primarily on current pharmaceutical prices and the willingness-to-pay per additional quality-adjusted life-year [QALY]. Conclusions Combination therapy using a combination of anti-TNFα [infliximab] and an immunomodulator is cost-effective in the treatment of Crohn’s disease compared with treatment cycles in which the immunomodulator is withdrawn. Combination treatment is cost-effective compared with treatment cycles in which infliximab is withdrawn, at prices of infliximab below€192/100 mg, given a willingness-to-pay threshold at€49 020 [Sweden] per additional QALY.

Cost-effectiveness of laparoscopic ileocaecal resection versus infliximab treatment of terminal ileitis in Crohn’s disease: the LIR!C Trial

Gut ◽  
2019 ◽  
Vol 68 (10) ◽  
pp. 1774-1780 ◽  
Author(s):  
E Joline de Groof ◽  
Toer W Stevens ◽  
Emma J Eshuis ◽  
Tjibbe J Gardenbroek ◽  
Judith E Bosmans ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Cost Effectiveness ◽  
Crohn's Disease ◽  
Controlled Trial ◽  
Cost Effective ◽  
Mean Difference ◽  
Infliximab Treatment ◽  
Resection Group ◽  
Life Years ◽  
Cost Effective Treatment

ObjectiveEvaluate the cost-effectiveness of laparoscopic ileocaecal resection compared with infliximab in patients with ileocaecal Crohn’s disease failing conventional therapy.DesignA multicentre randomised controlled trial was performed in 29 centres in The Netherlands and the UK. Adult patients with Crohn’s disease of the terminal ileum who failed >3 months of conventional immunomodulators or steroids without signs of critical strictures were randomised to laparoscopic ileocaecal resection or infliximab. Outcome measures included quality-adjusted life-years (QALYs) based on the EuroQol (EQ) 5D-3L Questionnaire and the Inflammatory Bowel Disease Questionnaire (IBDQ). Costs were measured from a societal perspective. Analyses were performed according to the intention-to-treat principle. Missing cost and effect data were imputed using multiple imputation. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated to show uncertainty.ResultsIn total, 143 patients were randomised. Mean Crohn’s disease total direct healthcare costs per patient at 1 year were lower in the resection group compared with the infliximab group (mean difference €−8931; 95% CI €−12 087 to €−5097). Total societal costs in the resection group were lower than in the infliximab group, however not statistically significant (mean difference €−5729, 95% CI €−10 606 to €172). The probability of resection being cost-effective compared with infliximab was 0.96 at a willingness to pay (WTP) of €0 per QALY gained and per point improvement in IBDQ Score. This probability increased to 0.98 at a WTP of €20 000/QALY gained and 0.99 at a WTP of €500/point of improvement in IBDQ Score.ConclusionLaparoscopic ileocaecal resection is a cost-effective treatment option compared with infliximab.Clinical trial registration numberDutch Trial Registry NTR1150; EudraCT number 2007-005042-20 (closed on 14 October 2015).

scholarly journals Evaluating the Cost-Effectiveness of Early Compared with Late or No Biologic Treatment to Manage Crohn’s Disease using Real-World Data

2019 ◽  
Vol 14 (4) ◽  
pp. 490-500 ◽  
Author(s):  
Nadia Pillai ◽  
Judith E Lupatsch ◽  
Mark Dusheiko ◽  
Matthias Schwenkglenks ◽  
Michel Maillard ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Cost Effectiveness ◽  
Crohn's Disease ◽  
Health System ◽  
Real World ◽  
Transition Probabilities ◽  
Cost Effective ◽  
Real World Data ◽  
World Data ◽  
The Cost

Abstract Background and Aims We evaluated the cost-effectiveness of early [≤2 years after diagnosis] compared with late or no biologic initiation [starting biologics >2 years after diagnosis or no biologic use] for adults with Crohn’s disease in Switzerland. Methods We developed a Markov cohort model over the patient’s lifetime, from the health system and societal perspectives. Transition probabilities, quality of life, and costs were estimated using real-world data. Propensity score matching was used to ensure comparability between patients in the early [intervention] and late/no [comparator] biologic initiation strategies. The incremental cost-effectiveness ratio [ICER] per quality-adjusted life year [QALY] gained is reported in Swiss francs [CHF]. Sensitivity and scenario analyses were performed. Results Total costs and QALYs were higher for the intervention [CHF384 607; 16.84 QALYs] compared with the comparator [CHF340 800; 16.75 QALYs] strategy, resulting in high ICERs [health system: CHF887 450 per QALY; societal: CHF449 130 per QALY]. In probabilistic sensitivity analysis, assuming a threshold of CHF100 000 per QALY, the probability that the intervention strategy was cost-effective was 0.1 and 0.25 from the health system and societal perspectives, respectively. In addition, ICERs improved when we assumed a 30% reduction in biologic prices [health system: CHF134 502 per QALY; societal: intervention dominant]. Conclusions Early biologic use was not cost-effective, considering a threshold of CHF100 000 per QALY compared with late/no biologic use. However, early identification of patients likely to need biologics and future drug price reductions through increased availability of biosimilars may improve the cost-effectiveness of an early treatment approach.

scholarly journals Cost–effectiveness of tacrolimus for the treatment of moderate-to-severe lupus nephritis in China

2019 ◽  
Vol 8 (13) ◽  
pp. 1125-1141
Author(s):  
Soyoung Kim ◽  
Adrian Yit Reen Ooi ◽  
Thomas Stephens ◽  
Hongsi Jiang
Keyword(s):  
Cost Effectiveness ◽  
Lupus Nephritis ◽  
Cost Effective ◽  
Original Form ◽  
Health States ◽  
Effectiveness Model ◽  
Life Years ◽  
Cost Effective Treatment ◽  
Tacrolimus Therapy ◽  
The Cost

Aim: Therapy for lupus nephritis (LN) requires treatment with immunosuppressive regimens, often including intravenous cyclophosphamide (IVCY), mycophenolate mofetil (MMF) or azathioprine. Additionally, tacrolimus (original form or generic) is recommended to treat LN patients in Asia, including China. However, the cost–effectiveness of tacrolimus therapy has not previously been assessed. We aimed to estimate the cost–effectiveness of tacrolimus in the treatment of moderate-to-severe LN versus standard therapies in China. Materials & methods: This cost–effectiveness model combined a decision-tree/Markov-model structure to map transitions between health states during induction and maintenance treatment phases. Induction with tacrolimus, IVCY or MMF, was followed by tacrolimus, MMF or azathioprine maintenance. Results: According to the model, during induction, complete remission rates were higher with tacrolimus versus IVCY (relative risk 1.40 vs IVCY [deterministic sensitivity analysis minimum 0.92, maximum 2.13]) and time to response was shorter. Relapse rates were lower with tacrolimus versus azathioprine or MMF during maintenance. Tacrolimus induction and maintenance was the most cost-effective regimen, incurring the lowest total costs (CN¥180,448) with the highest quality-adjusted life-years. Conclusion: The model demonstrated that tacrolimus use in both induction and maintenance therapy may be an efficacious and cost-effective treatment for LN in China.

scholarly journals Drug Utilization Pattern, Cost of Illness and Cost-Effective Analysis of Antihypertensive Drugs in a Tertiary Hospital- A Cross-Sectional Study

2021 ◽  
pp. 15-23
Author(s):  
K. V. Ramanath ◽  
Brijin Thomas Biju ◽  
Imad Ahmed ◽  
Mandapati Veera Venkata Haritha ◽  
K. S. Kishore
Keyword(s):  
Cost Effectiveness ◽  
Combination Therapy ◽  
Cost Of Illness ◽  
Antihypertensive Drugs ◽  
Cost Effective ◽  
Prescribing Patterns ◽  
Antihypertensive Medications ◽  
Public Health Burden ◽  
Cost Effective Treatment ◽  
The Cost

Background: Hypertension is a condition with a substantial public health burden and a high risk of cardiovascular disease. The increasing prevalence of hypertension requires the use of cost-effective treatment and effective management of a disease. Hence, this study aims to assess the cost-effectiveness of antihypertension drugs in patients with hypertension and other co- morbidities. Methods: The study was designed as prospective and interventional, with objectives to evaluate the cost of illness, prescribing patterns of different classes of antihypertensive drugs alone or in combination, and cost-effectiveness evaluation of other groups of antihypertensive drugs prescribed. Provided About 40 patients were with antihypertensive drugs of various classes whose health scores were calculated using the EQ-5D-5L questionnaire and calculated the total cost of treatment. Also calculated Most common Prescribe antihypertensive medications and the cost-effectiveness of each drug. Results: This study showed that 58% of patients received combination therapy, 42% received monotherapy. Metoprolol was most cost-effective, followed by Carvedilol, which was in the case of monotherapy. Concerning combination therapy, Amlodipine + Bisoprolol proved to be the most cost-effective. ARBs were the most commonly prescribed class of antihypertensive drugs. Conclusion: The study provided significant improvement in the health score of patients concerning the cost-effective antihypertensive treatment, showing an effective reduction in BP/ Helped in the management of hypertension and helped reduce risk factors associated with various cardiovascular diseases.

Cost-effectiveness of first-line pembrolizumab plus chemotherapy for metastatic squamous non-small cell lung cancer (NSCLC).

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e20703-e20703
Author(s):  
Ashley Kim ◽  
Beth Devine ◽  
Joshua A. Roth
Keyword(s):  
Cost Effectiveness ◽  
Combination Therapy ◽  
Cost Effective ◽  
Sensitivity Analyses ◽  
Base Case ◽  
First Line ◽  
Lifetime Horizon ◽  
Life Years ◽  
Tumor Expression ◽  
The Cost

e20703 Background: Trial results from KEYNOTE-407 have recently led to the FDA approval for pembrolizumab + carboplatin + paclitaxel/nab-paclitaxel (pembrolizumab+chemo) in previously untreated metastatic squamous NSCLC. This is the only first-line indication for squamous NSCLC regardless of tumor expression status. Our objective was to evaluate the cost-effectiveness of pembrolizumab combination therapy in this setting from the US payer perspective. Methods: Using data from KEYNOTE-407, we developed a partitioned survival decision model to estimate the lifetime costs and effectiveness of pembrolizumab+chemo vs. chemo alone in the first-line treatment of metastatic squamous NSCLC. The base case used a Weibull curve selected based on minimum AIC/BIC and best graphical fit to extrapolate in-trial survival to a lifetime horizon. First- and second-line therapy resource use and adverse event (AE) rates were derived from KEYNOTE-407. Utility data and AE management were obtained from published literature and national sources. Direct medical costs were adjusted to 2018 US dollars, and future costs and outcomes were discounted at 3% per year. We estimated life years (LY), quality-adjusted life years (QALYs), and costs over a lifetime horizon. One-way and probabilistic sensitivity analyses were also conducted. Results: In the base case, pembrolizumab+chemo resulted in 0.51 more LYs, 0.36 more QALYs, and $233,246 in healthcare costs vs. chemo alone. Costs per LY and QALY gained were $216,180 and $309,004, respectively. One-way sensitivity analyses indicated that the results were most sensitive to survival and pre-progression utility inputs. In a threshold analysis, we found that the cost of pembrolizumab+chemo would need to be reduced by 24% per course of therapy ($176,175) in order to be cost-effective at $150,000/QALY. Conclusions: Based on current available data, our analysis suggests first-line pembrolizumab-based combination therapy in metastatic squamous NSCLC is unlikely to be cost-effective relative to implied willingness to pay in cancer in the U.S. (ie < $150,000 per QALY). Future studies should reassess cost-effectiveness as trial data mature.

scholarly journals Tight control for Crohn’s disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial

Gut ◽  
2019 ◽  
Vol 69 (4) ◽  
pp. 658-664 ◽  
Author(s):  
Remo Panaccione ◽  
Jean-Frederic Colombel ◽  
Simon P L Travis ◽  
Peter Bossuyt ◽  
Filip Baert ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Cost Effectiveness ◽  
Crohn's Disease ◽  
Activity Index ◽  
Work Productivity ◽  
Cost Effective ◽  
Medical Costs ◽  
Sensitivity Analyses ◽  
Tight Control ◽  
Life Years

ObjectiveTo 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.DesignA 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.ResultsOver 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.ConclusionA 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.Trial registration numberNCT01235689; Results.

scholarly journals Cost–effectiveness analysis of empagliflozin compared with glimepiride in patients with Type 2 diabetes in China

2021 ◽  
Author(s):  
Ahmed Salem ◽  
Peng Men ◽  
Mafalda Ramos ◽  
Yan-Jun Zhang ◽  
Anastasia Ustyugova ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Quality Adjusted Life Years ◽  
System Perspective ◽  
Diabetes Model ◽  
Life Years ◽  
Cost Effective Treatment ◽  
The Cost

Aim: The study assesses the cost–effectiveness of empagliflozin versus glimepiride in patients with Type 2 diabetes and uncontrolled by metformin alone in China, based on the EMPA-REG H2H-SU trial. Materials & methods: A calibrated version of the IQVIA Core Diabetes Model was used. Cost of complications and utility were taken from literature. The Chinese healthcare system perspective and 5% discounting rates were applied. Results: Empagliflozin+metformin provides additional quality-adjusted life-years (0.317) driven by a reduction in the number of cardiovascular and renal events, for an additional cost of $1382 (CNY9703) compared with glimepiride+metformin. Conclusion: Empagliflozin is cost-effective treatment versus glimepiride applying a threshold of $30,290 (CNY212,676).

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