Health-economic analysis: cost-effectiveness of scheduled maintenance treatment with infliximab for Crohn's disease - modelling outcomes in active luminal and fistulizing disease in adults

Background Infliximab has been shown to be efficacious in moderate-to-severe Crohn's disease (CD). Aim To evaluate the cost-effectiveness of scheduled maintenance treatment with infliximab in luminal and fistulizing CD patients. Methods Markov models were constructed to simulate the progression of adult CD patients with and without fistulae during treatment with infliximab (5 mg/kg). Transitions were estimated from published clinical trials of infliximab. Standard care, comprising immunomodulators and/or corticosteroids was used as a comparator. An average weight of 60 kg was used to estimate the dose of infliximab. The costs and outcomes were discounted at 3.5% over 5 years. The primary effectiveness measurement was quality-adjusted life years (QALYs) estimated using EQ-5D. One-way and probabilistic sensitivity analyses were performed by varying the infliximab efficacy estimates, costs and utilities. Results The incremental cost per QALY gained was 26 pound 128 in luminal CD and 29 pound 752 in fistulizing CD at 5 years. Results were robust and remained in the range of 23 pound 752-38 pound 848 for luminal CD and 27 pound 047-44 pound 206 for fistulizing CD. Patient body weight was the most important factor affecting cost-effectiveness. Conclusion Eight-week scheduled maintenance treatment with infliximab is a cost-effective treatment for adult patients suffering from active luminal or fistulizing CD.