PSY57 - The Cost-Effectiveness of Biologics for The Treatment of Inflammatory Bowel Diseases: A Systematic Review

Abstract

Biologics are used for the treatment of inflammatory bowel diseases (IBDs), Crohn´s disease (CD) and Ulcerative colitis (UC), while their costs are significant high. To allocate health spending efficiently, biologics for IBDs are an important target for cost-effectiveness analyses. The aim of this study was to systemically review the cost-effectiveness of biologics for IBDs and to evaluate the methodological quality of cost-effectiveness analyses. The literature search was performed to Medline (Ovid), Cochrane Library and SCOPUS in June 2014. The cost-utility analyses of biologics for IBDs in adults were included in the review. Biologics were compared with conventional medical treatment, another biologic treatment, placebo and surgery. Data extraction form was designed beforehand. All costs were converted to 2014 euro. The methodological quality of the included studies was assessed by Drummond´s checklist, Philips´ checklist and Consolidated Health Economic Evaluation Reporting Standards (CHEERS) guideline. Of the 1828 references found in the literature search, 25 studies were included in the final review. The main causes affected the cost-effectiveness of the biologics are the activity of the disease, the duration of the biological treatment and the treatment strategy. Among patients refractory to conventional medical treatment (CMT) for IBD, incremental cost-effectiveness ratio (ICER) ranged from dominance to €549,335 per Quality-Adjusted Life Year (QALY) compared with CMT. Adalimumab produced more frequently lower ICERs than infliximab in comparison with CMT for CD. When compared biologics with another biologic treatment for CD, ICER ranged from dominance to €24,012,483/QALY. A study including both direct and indirect costs produced more favorable ICERs than studies including only direct costs. With a threshold of €35,000/QALY, current evidence showed that biologics are cost-effective for the induction treatment of active and severe IBD. Biologics were not cost-effective for moderate IBD. Between biologics the cost-effectiveness remains unclear.