Journal article
Tight control for Crohn's disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial
- Abstract:
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Objective 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.
Design 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.
Results 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.
Conclusion 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.
Trial registration number NCT01235689.
- Publication status:
- Published
- Peer review status:
- Peer reviewed
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(Preview, Version of record, pdf, 685.0KB, Terms of use)
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- Publisher copy:
- 10.1136/gutjnl-2019-318256
Authors
- Publisher:
- BMJ Publishing Group
- Journal:
- Gut More from this journal
- Volume:
- 69
- Issue:
- 4
- Pages:
- 658-664
- Publication date:
- 2019-07-08
- Acceptance date:
- 2019-06-12
- DOI:
- EISSN:
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1468-3288
- ISSN:
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0017-5749
- Pmid:
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31285357
- Language:
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English
- Keywords:
- Pubs id:
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pubs:1033058
- UUID:
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uuid:03ab2042-b70f-4e25-8240-bfc35e965c52
- Local pid:
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pubs:1033058
- Source identifiers:
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1033058
- Deposit date:
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2019-07-20
- ARK identifier:
Terms of use
- Copyright holder:
- Panaccione et al.
- Copyright date:
- 2019
- Rights statement:
- © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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