Early Surgery Versus Biologic Therapy in Limited Nonstricturing Ileocecal Crohn’s Disease—A Decision-making Analysis

Abstract

Background Surgery is the preferred option for patients with symptomatic localized fibrostenotic ileocecal Crohn’s disease (CD) but not for those with predominantly active inflammation without obstruction. The benefit of early surgery in patients with a limited nonstricturing ileocecal CD over biologic treatment is still a debate. Objective Our objective is to formulate a decision analysis model based on recently published data to explore whether early surgery in patients with limited nonstricturing CD is preferred over biologic treatment. Methods We constructed a Markov model comparing 2 strategies of treatment: (1) early surgery vs (2) biologic treatment. To estimate the quality-adjusted life years (QALYs) and the costs in each strategy, we simulated 10,000 virtual patients with the Markov model using a Monte Carlo simulation 100 times. Sensitivity analyses were performed to evaluate the robustness of the model and address uncertainties in the estimation of model parameters. Results The costs were $29,457 ± $407 and $50,382 ± $525 (mean ± SD) for early surgery strategy and biologic treatment strategy, respectively. The QALY was 6.24 ± 0.01 and 5.81 ± 0.01 for early surgery strategy and biologic treatment strategy, respectively. Conclusion The strategy of early surgery dominates (higher QALY value [efficacy] and less cost) compared with the strategy of biologic treatment in patients with limited ileocecal CD.

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“…A review conducted by Broide et al . [ 41 ] has also suggested that starting early biologics is more cost-effective when compared to surgery and conventional therapy among adults. Similar studies among children are necessary.…”

Surgical Management of Small Bowel Crohn's Disease

“…Some even question whether the role of medical therapy is to delay the eventuality of surgery (25,27). Several recent studies suggest surgical excision to provide a better quality of life and a significant reduction in cost compared to anti-TNF therapy in isolated ileocolic disease (25,29).…”

Laparoscopic bowel resection combined with infliximab treatment (LaRIC) versus infliximab for terminal ileitis in Crohn’s disease: a randomised, controlled, open-label trial

“…And long-term studies have shown that after resection, 50% of patients will never require reoperation. 11 Some evidence suggests that postoperative IFX treatment may lead to a lower recurrence rate (9.1%-24% within 1 year) compared with not using IFX postoperatively (81%-85% within 1 year). [12][13][14][15][16] However, several studies have shown that preoperative use of IFX can lead to an increased risk of postoperative complications such as sepsis, abdominal abscess and anastomotic leakage.…”