A model of the long‐term cost effectiveness of scheduled maintenance treatment with infliximab for moderate‐to‐severe ulcerative colitis

Tsai, Her Hsin; Punekar, Yogesh Suresh; Morris, Jonathan; Fortun, Paul

doi:10.1111/j.1365-2036.2008.03839.x

Cited by 60 publications

(79 citation statements)

References 18 publications

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“…The cost-effectiveness of anti-TNF-therapies versus standard care in patients with moderate-tosevere active UC following the failure of conventional therapy has previously been assessed within one UK study [25] and one Canadian study [37]. Xie et al [37] included adalimumab as a subsequentline therapy for non-responders to infliximab, whilst Tsai et al [25] is the same as that for active UC.…”

Section: Summary Of Headline Cost-effectiveness Resultsmentioning

confidence: 99%

“…Xie et al [37] included adalimumab as a subsequentline therapy for non-responders to infliximab, whilst Tsai et al [25] is the same as that for active UC. Importantly, neither of these studies include all relevant biologic treatment options or colectomy as comparators and both studies adopted short time horizons.…”

Section: Summary Of Headline Cost-effectiveness Resultsmentioning

confidence: 99%

“…The costs of conventional therapies were assumed to be the same for all treatment groups. Health state costs relating to the use of elective and emergency endoscopy, hospitalisations, consultant visits and blood tests were drawn from a previous modelling study reported by Tsai et al [25]. The relative risk of hospitalisation for infliximab and adalimumab was derived from an NMA reported by the manufacturer of infliximab and golimumab [26]; as no evidence was available on hospitalisation rates for golimumab, this was assumed to be the same as that for adalimumab.…”

Section: Resources and Costsmentioning

confidence: 99%

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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

et al. 2016

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Background: 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 UC 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-) therapies may improve medical outcomes albeit at an increased cost.Objective: 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.Methods: 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-TNFagents 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 2013/2014 prices.Results: 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 qualityadjusted life year (QALY) gained. Conclusions:Based on the NMAs, the ICERs for anti-TNF-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. KEY POINTS FOR DECISION-MAKERS• Colectomy is expected to be more effective and less expensive than medical treatments for ulcerative colitis.• For patients in whom colectomy is not an acceptable option, the ICERs for anti-TNFtherapy versus conventional treatment are in excess of £50,000 per QALY gained.• Using anti-TNF-therapy to induce remission, withdrawing therapy and re-treating upon relapse, may provide a more economically efficient approach, compared with continuous treatment in those achieving an induction response. The comparative effectiveness and costeffectiveness of this approach is however unclear.3

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Section: Summary Of Headline Cost-effectiveness Resultsmentioning

confidence: 99%

Section: Summary Of Headline Cost-effectiveness Resultsmentioning

confidence: 99%

Section: Resources and Costsmentioning

confidence: 99%

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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

et al. 2016

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“…78 The structure and formulae included in the manufacturers' submission models were scrutinised by two members of the Assessment Group (PT and HB). It should be noted that this appraisal includes an update of Technology Appraisal Guidance 140; 79 the economic evaluation reported within the 2007 Schering Plough submission to NICE 80 is not included in this review as it has previously been critiqued for NICE; 81 however, one of the studies included in the review 82 reports an analysis of this model.…”

Section: Review Methodsmentioning

confidence: 99%

“…[82][83][84] Cost-effectiveness evaluation of golimumab (with Patient Access Scheme), infliximab and adalimumab relative to colectomy for moderate to severe ulcerative colitis in the UK (MSD submissions 64,66 ) and Adalimumab, golimumab and infliximab, for the treatment of ulcerative colitis (subacute) -AbbVie submission 62 present critical reviews of the individual manufacturers' submissions from AbbVie and MSD, respectively.…”

Section: Assessment Of Cost-effectivenessmentioning

confidence: 99%

Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262): clinical effectiveness systematic review and economic model

Archer

Tappenden

Ren

et al. 2016

Health Technol Assess

143

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BackgroundUlcerative colitis (UC) is the most common form of inflammatory bowel disease in the UK. UC can have a considerable impact on patients’ quality of life. The burden for the NHS is substantial.ObjectivesTo evaluate the clinical effectiveness and safety of interventions, to evaluate the incremental cost-effectiveness of all interventions and comparators (including medical and surgical options), to estimate the expected net budget impact of each intervention, and to identify key research priorities.Data sourcesPeer-reviewed publications, European Public Assessment Reports and manufacturers’ submissions. The following databases were searched from inception to December 2013 for clinical effectiveness searches and from inception to January 2014 for cost-effectiveness searches for published and unpublished research evidence: MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, The Cochrane Library including the Cochrane Systematic Reviews Database, Cochrane Controlled Trials Register, Database of Abstracts of Reviews of Effects, the Health Technology Assessment database and NHS Economic Evaluation Database; ISI Web of Science, including Science Citation Index, and the Conference Proceedings Citation Index-Science and Bioscience Information Service Previews. The US Food and Drug Administration website and the European Medicines Agency website were also searched, as were research registers, conference proceedings and key journals.Review methodsA systematic review [including network meta-analysis (NMA)] was conducted to evaluate the clinical effectiveness and safety of named interventions. The health economic analysis included a review of published economic evaluations and the development of a de novo model.ResultsTen randomised controlled trials were included in the systematic review. The trials suggest that adult patients receiving infliximab (IFX) [Remicade®, Merck Sharp & Dohme Ltd (MSD)], adalimumab (ADA) (Humira®, AbbVie) or golimumab (GOL) (Simponi®, MSD) were more likely to achieve clinical response and remission than those receiving placebo (PBO). Hospitalisation data were limited, but suggested more favourable outcomes for ADA- and IFX-treated patients. Data on the use of surgical intervention were sparse, with a potential benefit for intervention-treated patients. Data were available from one trial to support the use of IFX in paediatric patients. Safety issues identified included serious infections, malignancies and administration site reactions. Based on the NMA, in the induction phase, all biological treatments were associated with statistically significant beneficial effects relative to PBO, with the greatest effect associated with IFX. For patients in response following induction, all treatments except ADA and GOL 100 mg at 32–52 weeks were associated with beneficial effects when compared with PBO, although these were not significant. The greatest effects at 8–32 and 32–52 weeks were associated with 100 mg of GOL and 5 mg/kg of IFX, respectively. For patients in remission following induction, all treatments except ADA at 8–32 weeks and GOL 50 mg at 32–52 weeks were associated with beneficial effects when compared with PBO, although only the effect of ADA at 32–52 weeks was significant. The greatest effects were associated with GOL (at 8–32 weeks) and ADA (at 32–52 weeks). The economic analysis suggests that colectomy is expected to dominate drug therapies, but for some patients, colectomy may not be considered acceptable. In circumstances in which only drug options are considered, IFX and GOL are expected to be ruled out because of dominance, while the incremental cost-effectiveness ratio for ADA versus conventional treatment is approximately £50,300 per QALY gained.LimitationsThe health economic model is subject to several limitations: uncertainty associated with extrapolating trial data over a lifetime horizon, the model does not consider explicit sequential pathways of non-biological treatments, and evidence relating to complications of colectomy was identified through consideration of approaches used within previous models rather than a full systematic review.ConclusionsAdult patients receiving IFX, ADA or GOL were more likely to achieve clinical response and remission than those receiving PBO. Further data are required to conclusively demonstrate the effect of interventions on hospitalisation and surgical outcomes. The economic analysis indicates that colectomy is expected to dominate medical treatments for moderate to severe UC.Study registrationThis study is registered as PROSPERO CRD42013006883.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Evaluation of the Cost-effectiveness of Infection Control Strategies to Reduce Hospital-Onset Clostridioides difficile Infection

et al. 2020

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IMPORTANCE Clostridioides difficile infection is the most common hospital-acquired infection in the United States, yet few studies have evaluated the cost-effectiveness of infection control initiatives targeting C difficile. OBJECTIVE To compare the cost-effectiveness of 9 C difficile single intervention strategies and 8 multiintervention bundles. DESIGN, SETTING, AND PARTICIPANTS This economic evaluation was conducted in a simulated 200-bed tertiary, acute care, adult hospital. The study relied on clinical outcomes from a published agent-based simulation model of C difficile transmission. The model included 4 agent types (ie, patients, nurses, physicians, and visitors). Cost and utility estimates were derived from the literature. INTERVENTIONS Daily sporicidal cleaning, terminal sporicidal cleaning, health care worker hand hygiene, patient hand hygiene, visitor hand hygiene, health care worker contact precautions, visitor contact precautions, C difficile screening at admission, and reduced intrahospital patient transfers. MAIN OUTCOMES AND MEASURES Cost-effectiveness was evaluated from the hospital perspective and defined by 2 measures: cost per hospital-onset C difficile infection averted and cost per quality-adjusted life-year (QALY). RESULTS In this agent-based model of a simulated 200-bed tertiary, acute care, adult hospital, 5 of 9 single intervention strategies were dominant, reducing cost, increasing QALYs, and averting hospital-onset C difficile infection compared with baseline standard hospital practices. They were daily cleaning (most cost-effective, saving $358 268 and 36.8 QALYs annually), health care worker hand hygiene, patient hand hygiene, terminal cleaning, and reducing intrahospital patient transfers.

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A model of the long‐term cost effectiveness of scheduled maintenance treatment with infliximab for moderate‐to‐severe ulcerative colitis

Abstract: SUMMARYBackground Infliximab (IFX) has been shown to be efficacious in moderate-severe ulcerative colitis (UC).

Cited by 60 publications

References 18 publications

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

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

Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262): clinical effectiveness systematic review and economic model

Evaluation of the Cost-effectiveness of Infection Control Strategies to Reduce Hospital-Onset Clostridioides difficile Infection

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