Abstract

BackgroundInflammatory bowel disease (IBD) is a chronic disease placing a large health and economic burden on health systems worldwide. The treatment landscape is complex with multiple strategies to induce and maintain remission while avoiding long-term complications. The extent to which rising treatment costs, due to expensive biologic agents, are offset by improved outcomes and fewer hospitalisations and surgeries needs to be evaluated. This systematic review aimed to assess the cost-effectiveness of treatment strategies for IBD.Materials and methodsA systematic literature search was performed in March 2017 to identify economic evaluations of pharmacological and surgical interventions, for adults diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC). Costs and incremental cost-effectiveness ratios (ICERs) were adjusted to reflect 2015 purchasing power parity (PPP). Risk of bias assessments and a narrative synthesis of individual study findings are presented.ResultsForty-nine articles were included; 24 on CD and 25 on UC. Infliximab and adalimumab induction and maintenance treatments were cost-effective compared to standard care in patients with moderate or severe CD; however, in patients with conventional-drug refractory CD, fistulising CD and for maintenance of surgically-induced remission ICERs were above acceptable cost-effectiveness thresholds. In mild UC, induction of remission using high dose mesalazine was dominant compared to standard dose. In UC refractory to conventional treatments, infliximab and adalimumab induction and maintenance treatment were not cost-effective compared to standard care; however, ICERs for treatment with vedolizumab and surgery were favourable.ConclusionsWe found that, in general, while biologic agents helped improve outcomes, they incurred high costs and therefore were not cost-effective, particularly for use as maintenance therapy. The cost-effectiveness of biologic agents may improve as market prices fall and with the introduction of biosimilars. Future research should identify optimal treatment strategies reflecting routine clinical practice, incorporate indirect costs and evaluate lifetime costs and benefits.

Highlights

  • Inflammatory bowel disease (IBD) refers mainly to Crohn’s disease (CD) and ulcerative colitis (UC), which are chronic, autoimmune conditions causing inflammation in the gastrointestinal tract and extra-intestinal complications

  • Infliximab and adalimumab induction and maintenance treatments were cost-effective compared to standard care in patients with moderate or severe CD; in patients with conventional-drug refractory CD, fistulising CD and for maintenance of surgically-induced remission incremental cost-effectiveness ratios (ICERs) were above acceptable cost-effectiveness thresholds

  • In UC refractory to conventional treatments, infliximab and adalimumab induction and maintenance treatment were not cost-effective compared to standard care; ICERs for treatment with vedolizumab and surgery were favourable

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Summary

Introduction

Inflammatory bowel disease (IBD) refers mainly to Crohn’s disease (CD) and ulcerative colitis (UC), which are chronic, autoimmune conditions causing inflammation in the gastrointestinal tract and extra-intestinal complications. Biologic agents are being used to induce remission in patients with moderate to severe disease and disease which responds poorly or is refractory to conventional medicines [5, 6]. Two antiintegrin molecules are available: vedolizumab, approved in the USA and Europe for CD and UC, and natalizumab, approved in the USA for CD only. These agents provide promising alternatives to conventional medications as they are associated with reduced dependence on corticosteroids as well as longer duration of remission and improved overall quality of life [8]. The treatment landscape is complex with multiple strategies to induce and maintain remission while avoiding long-term complications. This systematic review aimed to assess the cost-effectiveness of treatment strategies for IBD

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