A systematic review of cost-effectiveness studies comparing conventional, biological and surgical interventions for inflammatory bowel disease

Abstract

BackgroundInflammatory bowel disease (IBD) is a chronic disease placing a large health and economic burden on health systems worldwide. The treatment landscape is complex with multiple strategies to induce and maintain remission while avoiding long-term complications. The extent to which rising treatment costs, due to expensive biologic agents, are offset by improved outcomes and fewer hospitalisations and surgeries needs to be evaluated. This systematic review aimed to assess the cost-effectiveness of treatment strategies for IBD.Materials and methodsA systematic literature search was performed in March 2017 to identify economic evaluations of pharmacological and surgical interventions, for adults diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC). Costs and incremental cost-effectiveness ratios (ICERs) were adjusted to reflect 2015 purchasing power parity (PPP). Risk of bias assessments and a narrative synthesis of individual study findings are presented.ResultsForty-nine articles were included; 24 on CD and 25 on UC. Infliximab and adalimumab induction and maintenance treatments were cost-effective compared to standard care in patients with moderate or severe CD; however, in patients with conventional-drug refractory CD, fistulising CD and for maintenance of surgically-induced remission ICERs were above acceptable cost-effectiveness thresholds. In mild UC, induction of remission using high dose mesalazine was dominant compared to standard dose. In UC refractory to conventional treatments, infliximab and adalimumab induction and maintenance treatment were not cost-effective compared to standard care; however, ICERs for treatment with vedolizumab and surgery were favourable.ConclusionsWe found that, in general, while biologic agents helped improve outcomes, they incurred high costs and therefore were not cost-effective, particularly for use as maintenance therapy. The cost-effectiveness of biologic agents may improve as market prices fall and with the introduction of biosimilars. Future research should identify optimal treatment strategies reflecting routine clinical practice, incorporate indirect costs and evaluate lifetime costs and benefits.

A single administration of human adipose tissue-derived mesenchymal stromal cells (MSC) induces durable and sustained long-term regulation of inflammatory response in experimental colitis

“…ORIgInal aRTIClE remission periods. However, many patients are refractory, so that surgery remains their only alternative [13]. The partial inefficacy of pharmacological interventions and the unresponsiveness of some subjects has spurred clinical interest in developing other approaches for effectively controlling IBD.…”

“…IBD response is driven by cytokines and leukocyte infiltrate in the gut [5][6][7], with histological features of crypt cell hyperplasia, interstitial edema and mucosa ulcerations [8]. However, many patients are refractory, so that surgery remains their only alternative [13]. Accordingly, current available treatments are aimed at reducing inflammation in an attempt to avoid disease recurrence or to prolong clinical Clinical and Experimental Immunology ORIgInal aRTIClE remission periods.…”

The Future of Biosimilars: Maximizing Benefits Across Immune-Mediated Inflammatory Diseases

“…The cost-effectiveness of early biologic treatment in IBD is also being explored [135], whereas a model extrapolating data from the CALM trial in CD showed that "tight control," using biomarkers to direct adalimumab treatment, was cost-effective versus standard clinical management over 2-and 5-year timeframes, with cost-effectiveness improving over time [136]. Biosimilar uptake may also bring indirect economic benefits, often not considered in cost-effectiveness analyses [137]. In RA, effective early treatment with DMARDs [138] or biologics [139] can improve workforce productivity, with economic benefits for individuals and society.…”

Editorial: better outcomes for Crohn's disease—more than just the drugs?

“…Over time, the outcomes from using these drugs in the right patients, with the right targets, at the right dose and with the right combinations have incrementally improved . The cost reductions, now being seen with the availability of biosimilars, will further improve the cost‐effectiveness of this class . Finally, the identification of predictive biomarkers may lead to a more personalised approach to the use of these agents …”

“…8 The cost reductions, now being seen with the availability of biosimilars, will further improve the cost-effectiveness of this class. 9 Finally, the identification of predictive biomarkers may lead to a more personalised approach to the use of these agents. 10 Improvements in IBD outcomes over a decade may have many causes.…”