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A Model-Based Economic Evaluation of Biologic and Non-Biologic Options for the Treatment of Adults with Moderately-to-Severely Active Ulcerative Colitis after the Failure of Conventional Therapy.
- Source :
- PharmacoEconomics; Oct2016, Vol. 34 Issue 10, p1023-1038, 16p, 1 Diagram, 4 Charts, 1 Graph
- Publication Year :
- 2016
-
Abstract
- <bold>Background: </bold>Ulcerative colitis (UC) is the most common form of inflammatory bowel disease in the UK. Medical management aims to induce and maintain remission and to avoid complications and the necessity for surgical intervention. Colectomy removes the source of inflammation but is associated with morbidity and mortality. Newer anti-tumour necrosis factor (TNF)-α therapies may improve medical outcomes, albeit at an increased cost.<bold>Objective: </bold>Our objective was to assess the incremental cost effectiveness of infliximab, adalimumab and golimumab versus conventional therapy and surgery from a National Health Service (NHS) and Personal Social Services (PSS) perspective over a lifetime horizon.<bold>Methods: </bold>A Markov model was developed with health states defined according to whether the patient is alive or dead, current treatments received, history of colectomy and level of disease control. Transition probabilities were derived from network meta-analyses (NMAs) of trials of anti-TNF-α agents in the moderate-to-severe UC population. Health utilities, colectomy rates, surgical complications and resource use estimates were derived from literature. Unit costs were drawn from standard costing sources and literature and were valued at year 2013/2014 values.<bold>Results: </bold>For patients in whom surgery is an option, colectomy is expected to dominate all medical treatment options. For patients in whom colectomy is not an option, infliximab and golimumab are expected to be ruled out due to dominance, whilst the incremental cost-effectiveness ratio (ICER) for adalimumab versus conventional treatment is expected to be approximately £50,278 per quality-adjusted life-year (QALY) gained.<bold>Conclusions: </bold>Based on the NMAs, the ICERs for anti-TNF-α therapy versus conventional treatment or surgery are expected to be at best, in excess of £50,000 per QALY gained. The cost effectiveness of withdrawing biologic therapy upon remission and re-treating relapse is unknown. [ABSTRACT FROM AUTHOR]
- Subjects :
- ULCERATIVE colitis
INFLAMMATORY bowel diseases
COLECTOMY
INFLIXIMAB
ADALIMUMAB
GOLIMUMAB
THERAPEUTIC use of monoclonal antibodies
MONOCLONAL antibodies
COMPARATIVE studies
COST effectiveness
IMMUNOLOGICAL adjuvants
RESEARCH methodology
MEDICAL cooperation
PROBABILITY theory
RESEARCH
RESEARCH funding
TUMOR necrosis factors
EVALUATION research
QUALITY-adjusted life years
STATISTICAL models
CHEMICAL inhibitors
ECONOMICS
THERAPEUTICS
Subjects
Details
- Language :
- English
- ISSN :
- 11707690
- Volume :
- 34
- Issue :
- 10
- Database :
- Complementary Index
- Journal :
- PharmacoEconomics
- Publication Type :
- Academic Journal
- Accession number :
- 118091555
- Full Text :
- https://doi.org/10.1007/s40273-016-0409-9