Cost-Effectiveness of Budesonide Controlled Ileal Release (CIR) Capsules as Maintenance Therapy versus No Maintenance Therapy for Ileocaecal Crohn??s Disease in Sweden

Abstract

A decision-analytic model was designed to estimate the associated costs and outcomes of maintenance therapy for Crohn's disease with budesonide controlled ileal release (CIR) capsules (Entocort((R)) capsules, Astra Draco, Lund, Sweden) versus no maintenance therapy. A third-party payer perspective was adopted to compare the direct costs associated with the medication and healthcare resource use for each therapy over a period of 12 four-week cycles. The costs of routine patient care and the consequences of failure, in terms of relapses, acute therapies, hospitalisations and surgery, were included. The outcome was measured as the average number of days in remission per patient per 12-cycle period. Based on the assumptions in the model, the results show that budesonide CIR capsules are associated with a reduction of 16.6 (26%) days in relapse, i.e. a 6% increase in days in remission, over a one-year period compared with no maintenance therapy. Direct healthcare costs are increased by 6% or Swedish kronor (SEK) 1673 ($US1 ~ SEK7.60). Overall, the model shows that there are substantial (non-drug associated) cost offsets from using budesonide CIR capsules as maintenance therapy in Crohn's disease. These cost offsets, in addition to improvements in patients' well-being and quality of life, indicate that maintenance therapy is cost effective compared with no maintenance therapy. The cost per added day in remission is relatively modest (SEK101 ~ $US13). If indirect costs are added to the calculation, it is realistic to argue that a net saving to society would be most likely.