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Tight control for Crohn's disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial
R. Panaccione, JF. Colombel, SPL. Travis, P. Bossuyt, F. Baert, T. Vaňásek, A. Danalıoğlu, G. Novacek, A. Armuzzi, W. Reinisch, S. Johnson, M. Buessing, E. Neimark, J. Petersson, WJ. Lee, GR. D'Haens,
Jazyk angličtina Země Velká Británie
Typ dokumentu klinické zkoušky, fáze III, časopisecké články, randomizované kontrolované studie, práce podpořená grantem
NLK
ProQuest Central
od 1960-03-01 do Před 6 měsíci
Health & Medicine (ProQuest)
od 1960-03-01 do Před 6 měsíci
- MeSH
- adalimumab terapeutické užití MeSH
- analýza nákladů a výnosů MeSH
- antiflogistika terapeutické užití MeSH
- biologické markery metabolismus MeSH
- C-reaktivní protein metabolismus MeSH
- Crohnova nemoc farmakoterapie metabolismus MeSH
- hospitalizace MeSH
- kvalitativně upravené roky života MeSH
- leukocytární L1-antigenní komplex metabolismus MeSH
- lidé MeSH
- určení symptomu MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- klinické zkoušky, fáze III MeSH
- práce podpořená grantem MeSH
- randomizované kontrolované studie MeSH
- Geografické názvy
- Spojené království MeSH
OBJECTIVE: To evaluate the cost-effectiveness of an inflammatory biomarker and clinical symptom directed tight control strategy (TC) compared with symptom-based clinical management (CM) in patients with Crohn's disease (CD) naïve to immunosuppressants and biologics using a UK public payer perspective. DESIGN: A regression model estimated weekly CD Activity Index (CDAI)-based transition matrices (remission: CDAI <150, moderate: CDAI ≥150 to <300, severe: CDAI ≥300 to <450, very severe: CDAI ≥450) based on the Effect of Tight Control Management on Crohn's Disease (CALM) trial. A regression predicted hospitalisations. Health utilities and costs were applied to health states. Work productivity was monetised and included in sensitivity analyses. Remission rate, CD-related hospitalisations, adalimumab injections, other direct medical costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated. RESULTS: Over 48 weeks, TC was associated with a higher clinical remission (CDAI <150) rate (58.2% vs 46.8%), fewer CD-related hospitalisations (0.124 vs 0.297 events per patient) and more injections of adalimumab (40 mg sc) (mean 31.0 vs 24.7) than CM. TC was associated with 0.032 higher QALYs and £593 higher total medical costs. The ICER was £18 656 per QALY. The ICER was cost-effective in 57.9% of simulations. TC became dominant, meaning less costly but more effective, when work productivity was included. CONCLUSION: A TC strategy as used in the CALM trial is cost-effective compared with CM. Incorporating costs related to work productivity increases the economic value of TC. Cross-national inferences from this analysis should be made with caution given differences in healthcare systems. TRIAL REGISTRATION NUMBER: NCT01235689; Results.
AbbVie Inc North Chicago Illinois USA
Department of Gastroenterology University Hospitals Leuven Leuven Belgium
Department of Internal Medicine 4 Medical University of Vienna Vienna Austria
Department of Medicine 4 Medical University Vienna Vienna Austria
Gastroenterology AMC Amsterdam The Netherlands
Gastroenterology Department Bezmialem Vakıf University Istanbul Turkey
Gastroenterology Imelda General Hospital Bonheiden Belgium
Gastroenterology John Radcliffe Hospital Oxford UK
Inflammatory Bowel Disease Unit University of Calgary Calgary Alberta Canada
Internal Medicine and Gastroenterology Catholic University Rome Italy
Citace poskytuje Crossref.org
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- $a OBJECTIVE: To evaluate the cost-effectiveness of an inflammatory biomarker and clinical symptom directed tight control strategy (TC) compared with symptom-based clinical management (CM) in patients with Crohn's disease (CD) naïve to immunosuppressants and biologics using a UK public payer perspective. DESIGN: A regression model estimated weekly CD Activity Index (CDAI)-based transition matrices (remission: CDAI <150, moderate: CDAI ≥150 to <300, severe: CDAI ≥300 to <450, very severe: CDAI ≥450) based on the Effect of Tight Control Management on Crohn's Disease (CALM) trial. A regression predicted hospitalisations. Health utilities and costs were applied to health states. Work productivity was monetised and included in sensitivity analyses. Remission rate, CD-related hospitalisations, adalimumab injections, other direct medical costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated. RESULTS: Over 48 weeks, TC was associated with a higher clinical remission (CDAI <150) rate (58.2% vs 46.8%), fewer CD-related hospitalisations (0.124 vs 0.297 events per patient) and more injections of adalimumab (40 mg sc) (mean 31.0 vs 24.7) than CM. TC was associated with 0.032 higher QALYs and £593 higher total medical costs. The ICER was £18 656 per QALY. The ICER was cost-effective in 57.9% of simulations. TC became dominant, meaning less costly but more effective, when work productivity was included. CONCLUSION: A TC strategy as used in the CALM trial is cost-effective compared with CM. Incorporating costs related to work productivity increases the economic value of TC. Cross-national inferences from this analysis should be made with caution given differences in healthcare systems. TRIAL REGISTRATION NUMBER: NCT01235689; Results.
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