Is Scheduled Maintenance Treatment with Infliximab Cost Effective in Patients with Crohn's Disease?

Abstract

Background: Infliximab has been shown to be efficacious in moderate-severe patients with Crohn's disease (CD). This study evaluates if scheduled maintenance treatment with infliximab, the only biologic licensed in paediatric and fistulising CD, is cost effective in all of its licensed CD patients. Objectives: To estimate the cost effectiveness of scheduled maintenance treatment with infliximab among children and adults with moderate-severe luminal CD and adults with moderate-severe fistulising CD. Methods: A Markov model was constructed to simulate the progression of hypothetical cohorts of paediatric and adult CD patients through predefined health states on scheduled maintenance treatment with infliximab (5 mg/kg). The transitions through these states were estimated from published clinical trials of infliximab. The health states used in the model were remission, therapy (infliximab) responsive active disease with/without draining/closed fistula, non-responsive active disease, surgery, post surgery remission and post surgery complications. Standard care, comprising immunomodulators and/or corticosteroids was used as a comparator. The primary outcome was quality adjusted life years (QALYs) estimated using EQ-5D from a European CD population. Average weights of 60 kg and 40 kg were used for adults and children respectively to estimate the dose of infliximab. The costs and outcomes were discounted at 3.5% over a period of 5 years. Probabilistic sensitivity analyses (PSA) were performed by varying the infliximab efficacy estimates, costs and utilities. Conclusion: Scheduled maintenance treatment with infliximab (5 mg/kg) is a cost effective treatment option for adult patients suffering from severe active CD under an 8-week scheduled maintenance programme.