PGI7 Budget IMPACT of Capsule Endoscopy for Crohn's Disease Management in Spain

Abstract

In Spain, endoscopic evaluation of Crohn’s disease with ileocolonoscopy±magnet resonance enteroscopy is the standard of care (SoC) for surveillance of the mucosa of the colon but not the small bowel (SB). Pan-intestinal video capsule endoscopy (PVCE) allows to visualize both the colon and small bowel in one exam, but the cost impact of introducing PVCE is unknown. From the National Healthcare System perspective, we estimate the budget impact of introducing PVCE in patients diagnosed with SB disease. A patient-level model was developed for describing the care pathway of the disease over a five-year time horizon in a cohort of 4,000 patients who started with CD surveillance at 1-year after diagnosis. A scenario using SoC for all patients was compared to a scenario in which SoC was considered for patients with colonic disease and PVCE (+patency capsule) was used for those patients with diagnosed SB disease. Information about efficacy, resource utilization, and unit costs (€2018) was taken from published sources and validated by Spanish experts. Sensitivity analyses were performed to assess the robustness of the model. Total costs per patient were lower when PVCE (+patency capsule) for SB diagnosed patients was used: €5,413 versus €5,464. Cost associated with monitoring increased by 7.1% (€851 vs €795) whereas pharmacological treatment, complications, and surgery costs all decreased: 1.5% (€3,089 vs €3,137), 4.9% (€577 vs €606), and 3.3% (€896 vs €926), respectively. suggested median total savings of €50 per patient, but it did not reach significance. 47% of patients were switched to PVCE over the time horizon, with the mean saving per switched-patient being €759. This simulation study suggests that using PVCE for patients with diagnosed SB disease is likely to reduce costs in the Spanish setting and could lead to reductions in surgery over a 5-year time period.