PGI27 Impact of Linaclotide Treatment on Work Productivity and Activity Impairment in Adults With Irritable Bowel Syndrome With Constipation

Abstract

OBJECTIVES: Infliximab is indicated in Crohn's disease (CD) resistant to standard treatment (ST), but its impact on health care costs and quality-adjusted life-expectancy is incompletely understood. We assessed the cost-effectiveness of episodic (ET) and maintenance (MT) infliximab treatment in CD patients with 10-years follow-up. METHODS: A total of 212 incident adult CD patients (age at onset 34.4Ϯ14.5 years, 49.4% male) were treated with antibiotics, mesalazine, corticosteroids, thiopurines, surgery (comprising ST) over 10-years to 2004. Eight health states were defined by intensity of therapy in these patients. We determined Markov transition probabilities between these states, health care costs and QALYs in 3 month-cycles. This cohort was modeled to allow drug-refractory or pre-surgery patients to receive infliximab: either ET in one cycle, or MT in responders for a period of 1-year (MT-1yr) or for 10-years (MT-10 yrs). Transition probabilities of ST were applied to patients getting IFX; the probability of continuing infliximab in MT was set to correct for decay. Health care costs and QALYs in ET and MT were estimated for 10-years (discounted at 3%) and compared with those of ST patients. RESULTS:The average cost (QALYs gained) per patient over 10-years was €23,169 (6.7014) for ST; €21,691 (7.0403) for ET, €29,012 (7.0553) for MT-1yr, and €50,416 (7.2603) for MT-10 yrs. ST was associated with higher costs and lower outcomes and was thus dominated by ET. The incremental cost-effectiveness ratios (ICERs) of MT-1yr and MT-10 yrs over ST were €16,510/QALY gained, and €48,751/QALY gained, respectively. When compared with ET, the ICERs of MT-1yr and MT-10 yrs were €488,066/QALY gained, and €130,568/QALY gained, respectively. When the infliximab price was halved these ICERs remained very high. CONCLUSIONS: ET or MT with infliximab are either cost-saving or cost-effective when compared with ST. However, at current drug prices, MT does not provide good value for money when compared with ET. OBJECTIVES:To evaluate direct medical costs, health outcomes, and cost-effectiveness of 48-week Peginterferon alpha-2a with 2nd line 2-years Entecavir treatment versus 3 years Entecavir treatment for HBeAg-positive chronic hepatitis B according to the Response Guided Treatment (RGT) strategy in China. METHODS: A Markov model was designed to evaluate the direct medical costs and outcomes (life years and QALYs gained) of treating HBeAg-positive chronic hepatitis B in China, with a maximum analysis time horizon of 80 years. The model included 10 health states -Chronic hepatitis B (CHB), HBeAg seroconversion, HBsAg loss, CHB with resistance, Compensated cirrhosis, Decompensated cirrhosis, Hepatocellular carcinoma, Liver transplant, Post-liver transplant and death. Based on the analysis of published literature, a two-round expert panel survey was conducted among 22 hepatitis B specialists nationally to identify clinical and utility data. From the perspective of China's health insurance system, cost data was calculated based on the publ...

Comprehensive assessment of patients with irritable bowel syndrome with constipation and chronic idiopathic constipation using deterministically linked administrative claims and patient-reported data: the Chronic Constipation and IBS-C Treatment and Outcomes Real-World Research Platform (CONTOR)

“…Despite this, few patients with IBS-C/CIC are on prescription therapy-only 1 in 3 (36%) CONTOR participants, congruent with the 12% to 35% range found in previous analyses 9,10,18 -even though many reported persistent burdensome symptoms. Together with findings that prescription medications are associated with higher treatment satisfaction and reduced healthcare resource utilization and costs [28][29][30] , our results suggest some IBS-C/CIC patients may benefit from these treatments but do not receive them.…”

“…The mistaken perception that lower symptom severity, as measured on a validated instrument, necessarily correlates with negligible impact on daily life may limit payer coverage or lead physicians to delay prescribing treatment, which may contribute to ongoing symptoms and reduced treatment satisfaction. Data from CONTOR afford a better understanding of how less-severe but chronic symptoms affect patient wellbeing, which could improve management of IBS-C/CIC, increase patient quality of life, and potentially help reduce the higher healthcare costs 5,6,19,35 and healthcare resource utilization 31,33 consistently found among patients with these conditions [28][29][30] .…”

A Diet Low in Fermentable Oligo-, Di-, and Monosaccharides and Polyols Improves Quality of Life and Reduces Activity Impairment in Patients With Irritable Bowel Syndrome and Diarrhea

“…Few IBS treatments have demonstrated benefits for these important outcomes. 37 The low-FODMAP diet led to a statistically significant improvement in absenteeism and presenteeism at 4 weeks when compared with baseline. However, between-group differences for absenteeism and presenteeism were not statistically significant.…”

Does a diet low in FODMAPs reduce symptoms associated with functional gastrointestinal disorders? A comprehensive systematic review and meta-analysis

“…Another study reported that patients with IBS type symptoms eat a higher FODMAP diet, but there was no association with level of fiber intake suggesting that modifying FODMAP intake may alter spectrum of IBS symptoms; however, there is no need to modify dietary fiber [46]. Therefore, further research is required to look at potential treatment for constipation in those with IBS that can be used in conjunction with a low FODMAP diet such as linaclotide which has been shown to improve constipation in a recent RCT [48].…”