Journal
EXPERT REVIEW OF PHARMACOECONOMICS & OUTCOMES RESEARCH
Volume 14, Issue 6, Pages 815-824Publisher
TAYLOR & FRANCIS LTD
DOI: 10.1586/14737167.2014.957682
Keywords
cost-effectiveness analysis; crohn's disease; decision analysis; health economics; inflammatory bowel disease
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In refractory Crohn's disease, anti-TNF and anti- 4 integrin agents are used for ameliorating disease activity but impose high costs to health-care systems. The authors systematically reviewed cost-effectiveness analyses based on decision models: most of the studies were judged to have a good quality, but a large portion assessed health and costs in a short time horizon, usually disregarding fistulizing disease and not considering safety. Infliximab induction followed by on-demand retreatment consistently proved to have a good cost per quality-adjusted life year, while maintenance treatment never satisfied commonly accepted cost-utility thresholds. Challenges in cost-effectiveness analysis include the lack of a standard model structure, a large variability in the costs of surgery and poor data on indirect costs. As clinical practice is moving to mucosal healing as a robust response marker, personalized schedules of anti-TNF therapies might prove cost-effective even in the perspective of the health-care system in the near future.
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