Early Initiation of Tumor Necrosis Factor Antagonist–Based Therapy for Patients With Crohn’s Disease Reduces Costs Compared With Late Initiation

Beilman, Candace L.; Kirwin, Erin; Ma, Christopher; McCabe, Christopher; Fedorak, Richard N.; Halloran, Brendan P.

doi:10.1016/j.cgh.2018.07.032

Cited by 14 publications

(6 citation statements)

References 25 publications

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“…One study was found that assessed cost effectiveness of early (within 2 years of CD diagnosis) versus late (more than 2 years after diagnosis) treatment with biologics . In a Canadian setting, a Markov model was developed to simulate the progression of a hypothetical cohort of patients with CD after the initiation of either infliximab or adalimumab.…”

Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis: efficacy and safety of early biologic treatment in adult and paediatric patients with Crohn’s disease

Ungaro

Aggarwal

Topaloglu

et al. 2020

Aliment Pharmacol Ther

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Background: There is an increasing body of evidence showing that earlier use of biologics improves clinical outcomes in Crohn's disease (CD). Aim:To perform a systematic review and meta-analysis to assess the impact of early biologic use in the treatment of CD. Methods: PubMed and Embase databases were searched for English language papers and conference abstracts published through April 30, 2019. Studies were selected for inclusion if patients initiated biologics within 2 years of a CD diagnosis or if earlier biologics use (top-down) was compared with a conventional step-up strategy. Randomeffects meta-analyses were conducted to compare clinical remission (CR), relapse and endoscopic healing rates between early biologic treatment (<2 years of disease duration or top-down treatment strategy) and late/conventional treatment (biologic use after >2 years of disease duration or conventional step-up treatment strategy).Results: A total of 3069 records were identified, of which 47 references met the selection criteria for systematic review. A total of 18 471 patients were studied, with a median follow-up of 64 weeks (range 10-416). Meta-analysis found that early use of biologics was associated with higher rates of clinical remission (OR 2.10 [95% CI:1.69-2.60], n = 2763, P < 0.00001), lower relapse rates (OR 0.31 [95% CI: 0.14-0.68], n = 596, P = 0.003) and higher mucosal healing rates (OR 2.37 [95% CI: 1.78-3.16], n = 994, P < 0.00001) compared with late/conventional management. Conclusions:Early biologic treatment is associated with improved clinical outcomes in both adult and paediatric CD patients, not only in prospective clinical trials but also in real-world settings.

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Section: Resultsmentioning

confidence: 99%

Systematic review and meta‐analysis: efficacy and safety of early biologic treatment in adult and paediatric patients with Crohn’s disease

Ungaro

Aggarwal

Topaloglu

et al. 2020

Aliment Pharmacol Ther

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“…Recently, a Korean population-based study also demonstrated that anti-TNF agents accounted for 93.1% of all medication costs and 68.8% of the total cost in 2015 [20]. However, a Canadian study found that early initiation of anti-TNF therapy (both infliximab and adalimumab) within 2 years of CD diagnosis provides significant cost savings and quality-adjusted life-years compared with later initiation [21]. This study suggests that early anti-TNF therapy has the potential not only to improve clinical outcomes, but also to reduce the economic burden associated with CD [21].…”

Section: Discussionmentioning

confidence: 99%

“…However, a Canadian study found that early initiation of anti-TNF therapy (both infliximab and adalimumab) within 2 years of CD diagnosis provides significant cost savings and quality-adjusted life-years compared with later initiation [21]. This study suggests that early anti-TNF therapy has the potential not only to improve clinical outcomes, but also to reduce the economic burden associated with CD [21]. The cost effectiveness of early initiation of anti-TNF therapy may be different between countries, because the medical environments vary among different countries and the effect of anti-TNF therapy may vary from race to race.…”

Section: Discussionmentioning

confidence: 99%

Impact of early anti-TNF use on clinical outcomes in Crohn’s disease: a nationwide population-based study

Jung

Han

Park

et al. 2020

Korean J Intern Med

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Background/Aims: The optimal timing for initiation of anti-tumor necrosis factor (TNF) therapy in Crohn's disease (CD) is still debated. Little is known about the clinical outcomes of early versus late administration of anti-TNF agents, especially in Asian CD patients. We aimed to evaluate the impact of early anti-TNF therapy on clinical outcomes in Korean CD patients. Methods: Using the Korean National Health Insurance Claims database, we collected data on patients diagnosed with CD who received anti-TNF therapy for more than 6 months between 2010 and 2016. Early initiation of anti-TNF therapy was defined as those starting infliximab or adalimumab therapy within 1 year of diagnosis. The following outcomes were assessed using a Cox proportional hazard model: abdominal surgery, CD-related emergency room (ER) visit, CD-related hospitalization, and new corticosteroid use. Results: Among 1,207 patients, 609 were early initiators of anti-TNF. Late anti-TNF initiation (> 1 year after diagnosis) was associated with increased risk of surgery (adjusted hazard ratio [aHR], 1.64; 95% confidence interval [CI], 1.05 to 2.55) and tended to be associated with increased risk of ER visit (aHR, 1.38; 95% CI, 0.99 to 1.94). However, there were no significant differences in the risk of hospitalization and corticosteroid use between early and late initiators. Conclusions: Early anti-TNF therapy among Korean CD patients within 1 year of diagnosis was associated with better clinical outcomes than late therapy, such as lower surgery and ER visit rates. Our results suggest that aggressive medical intervention in the early stages of CD may potentially change the course of this disease.

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“…These studies are limited in scope, however, since only induction of remission was evaluated and follow-up was short. Another analysis, using seven years of follow-up data from a retrospective cohort study in Canada 14 , demonstrated that early treatment with biologic agents was cost-saving and improved health outcomes over patients' lifetime due to high response rates 15 . However, several…”

mentioning

confidence: 99%

Evaluating the Cost-Effectiveness of Early Compared with Late or No Biologic Treatment to Manage Crohn’s Disease using Real-World Data

Pillai

Lupatsch

Dusheiko

et al. 2019

Journal of Crohn's and Colitis

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Background and Aims We evaluated the cost-effectiveness of early [≤2 years after diagnosis] compared with late or no biologic initiation [starting biologics >2 years after diagnosis or no biologic use] for adults with Crohn’s disease in Switzerland. Methods We developed a Markov cohort model over the patient’s lifetime, from the health system and societal perspectives. Transition probabilities, quality of life, and costs were estimated using real-world data. Propensity score matching was used to ensure comparability between patients in the early [intervention] and late/no [comparator] biologic initiation strategies. The incremental cost-effectiveness ratio [ICER] per quality-adjusted life year [QALY] gained is reported in Swiss francs [CHF]. Sensitivity and scenario analyses were performed. Results Total costs and QALYs were higher for the intervention [CHF384 607; 16.84 QALYs] compared with the comparator [CHF340 800; 16.75 QALYs] strategy, resulting in high ICERs [health system: CHF887 450 per QALY; societal: CHF449 130 per QALY]. In probabilistic sensitivity analysis, assuming a threshold of CHF100 000 per QALY, the probability that the intervention strategy was cost-effective was 0.1 and 0.25 from the health system and societal perspectives, respectively. In addition, ICERs improved when we assumed a 30% reduction in biologic prices [health system: CHF134 502 per QALY; societal: intervention dominant]. Conclusions Early biologic use was not cost-effective, considering a threshold of CHF100 000 per QALY compared with late/no biologic use. However, early identification of patients likely to need biologics and future drug price reductions through increased availability of biosimilars may improve the cost-effectiveness of an early treatment approach.

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Early Initiation of Tumor Necrosis Factor Antagonist–Based Therapy for Patients With Crohn’s Disease Reduces Costs Compared With Late Initiation

Cited by 14 publications

References 25 publications

Systematic review and meta‐analysis: efficacy and safety of early biologic treatment in adult and paediatric patients with Crohn’s disease

Systematic review and meta‐analysis: efficacy and safety of early biologic treatment in adult and paediatric patients with Crohn’s disease

Impact of early anti-TNF use on clinical outcomes in Crohn’s disease: a nationwide population-based study

Evaluating the Cost-Effectiveness of Early Compared with Late or No Biologic Treatment to Manage Crohn’s Disease using Real-World Data

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