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Cost-effectiveness of early colectomy with ileal pouch-anal anastamosis versus standard medical therapy in severe ulcerative colitis.
- Source :
-
Annals of surgery [Ann Surg] 2012 Jul; Vol. 256 (1), pp. 117-24. - Publication Year :
- 2012
-
Abstract
- Background: Inflammatory bowel diseases are costly chronic gastrointestinal diseases. We aimed to determine whether immediate colectomy with ileal pouch-anal anastamosis (IPAA) after diagnosis of severe ulcerative colitis (UC) was cost-effective compared to the standard medical therapy.<br />Methods: We created a Markov model simulating 2 cohorts of 21-year-old patients with severe UC, following them until 100 years of age or death, comparing early colectomy with IPAA strategy to the standard medical therapy strategy. Deterministic and probabilistic analyses were performed.<br />Results: Standard medical care accrued a discounted lifetime cost of $236,370 per patient. In contrast, early colectomy with IPAA accrued a discounted lifetime cost of $147,763 per patient. Lifetime quality-adjusted life-years gained (QALY-gained) for standard medical therapy was 20.78, while QALY-gained for early colectomy with IPAA was 20.72. The resulting incremental cost-effectiveness ratio (Δcosts/ΔQALY) was approximately $1.5 million per QALY-gained. Results were robust to one-way sensitivity analyses for all variables in the model. Quality-of-life after colectomy with IPAA was the most sensitive variable impacting cost-effectiveness. A low utility value of less than 0.7 after colectomy with IPAA was necessary for the colectomy with IPAA strategy to be cost-ineffective.<br />Conclusions: Under the appropriate clinical settings, early colectomy with IPAA after diagnosis of severe UC reduces health care expenditures and provides comparable quality of life compared to exhaustive standard medical therapy.
- Subjects :
- Antibodies, Monoclonal therapeutic use
Colitis, Ulcerative economics
Cost-Benefit Analysis
Decision Support Techniques
Gastrointestinal Agents therapeutic use
Humans
Infliximab
Markov Chains
Monte Carlo Method
Quality of Life
Time Factors
Colectomy economics
Colitis, Ulcerative drug therapy
Colitis, Ulcerative surgery
Colonic Pouches economics
Subjects
Details
- Language :
- English
- ISSN :
- 1528-1140
- Volume :
- 256
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Annals of surgery
- Publication Type :
- Academic Journal
- Accession number :
- 22270693
- Full Text :
- https://doi.org/10.1097/SLA.0b013e3182445321