Non‐invasive monitoring and treat‐to‐target approach are cost‐effective in patients with mild–moderate ulcerative colitis

Abstract

Background: There are no data to assess the value associated with a treat-to-target (T2T) strategy based on tight control of mild-moderate ulcerative colitis (UC). Aim: To assess the cost-effectiveness of a T2T approach based on the normalisation of clinical signs and faecal calprotectin (FC) Methods: A decision analytical Markov model was developed to compare T2T algorithm combining clinical symptoms and FC levels to define treatment response and the possible switch to the next treatment line (T2T-FC), and the reference strategy based only on symptoms. The model included five treatment lines and was conducted from the Italian national health service (NHS) perspective using a 3-year time horizon. The model calculated the incremental cost-effectiveness ratio as € per relapse avoided. Deterministic and probabilistic sensitivity analyses were conducted. Results:The cost-effectiveness analysis produced an increased time spent by a patient in clinical remission and FC ≤ 100 level (+0.177 years; about 2 months) and a decreasing number of relapses (−0.1937; −20.9%) per patient using a T2T-FC approach compared to only symptoms. Furthermore, the T2T-FC was associated with higher cost (+€1795). The ICER estimated was €9263 per relapse avoided. These results were confirmed by sensitivity analyses.Conclusions: T2T-FC approach resulted in a higher benefit for mild-moderate UC patients in terms of time in remission and incidence of relapse but was associated with higher costs. Clinical trials and real-world clinical studies are needed to provide additional data on the cost-benefit of this approach.

Review article: Translating STRIDE‐II into clinical reality – Opportunities and challenges

“…52 On the other hand, Cortesi et al showed in an economic evaluation (by a Markov analysis, not a cohort study) that a treat-to-target approach could be cost-effective in patients with mild-to-moderate UC and can improve time in clinical remission while reducing the risk of relapse compared to conventional treatment. 53 Therefore, reliable predictors of the effectiveness and potential side effects of different treatment approaches for individual patients could be of great importance. Such predictors would also be a good and necessary basis for assessing whether intensification of therapy or a change in therapy would be appropriate for the individual patient.…”

“…As for UC, things are a bit more controversial, 50,51 with a recent meta‐analysis suggesting little benefit of early biologic treatment in UC 52 . On the other hand, Cortesi et al showed in an economic evaluation (by a Markov analysis, not a cohort study) that a treat‐to‐target approach could be cost‐effective in patients with mild‐to‐moderate UC and can improve time in clinical remission while reducing the risk of relapse compared to conventional treatment 53 …”

Editorial: treat‐to‐target in ulcerative colitis clinical management—a small price to pay? Authors' reply

“…Declaration of personal interests : The authors' declarations of personal and financial interests are unchanged from those in the original article 7 …”

“…No specific studies have been conducted to estimate the potential value of a treat‐to‐target (T2T) strategy based on tight control in UC. Our study provided the first attempt to define the potential cost‐effectiveness of a T2T approach aiming to achieve resolution of clinical signs of disease activity and objective resolution of inflammation assessed by biomarkers (FC) compared to the standard approach based only on symptoms 7 . The T2T approach led to better outcomes and higher costs (because of greater biologic usage) with an incremental cost‐effectiveness ratio (ICER) of €9263 per relapse avoided, and a reasonable increment in treatment investment of €598 per patient year.…”

Editorial: treat‐to‐target in ulcerative colitis clinical management—a small price to pay?

“…Cortesi et al 3 performed a cost‐effectiveness analysis using hypothetical patients with mild–to‐moderate ulcerative colitis to evaluate the economic impacts of the T2T strategy. The T2T endpoint was faecal calprotectin, whereas the reference group endpoint was clinical symptoms.…”