Cost savings using a test-based de-escalation strategy for patients with Crohn's disease in remission on optimized infliximab: A discrete event model study

Background: Drug de-escalation is considered in Crohn's disease patients in sustained remission on optimized infliximab treatment. Aim: We built a model to evaluate the magnitude of cost savings in patients' disease course with or without drug de-escalation guided by infliximab trough levels. Methods: We designed 4 virtual cohorts (P1-P4) of 10,000 patients in clinical remission on optimized infliximab treatment followed for 2 years. P1: no drug de-escalation 10 mg/kg/8 weeks; P2: drug de-escalation from 10 mg/kg/8 weeks to 5 mg/kg/8 weeks according to trough levels; P3: no drug deescalation 10 mg/kg/6 weeks; and P4: drug de-escalation from 10 mg/kg/6 weeks to 10 mg/kg/8 weeks according to trough levels. For P2 and P4 cohorts, drug de-escalation was decided if trough levels were >= 7 mu g/mL and no de-escalation if trough levels were <7 mu g/mL. Only costs related to drug administration were considered. Results: The cost differences when comparing P1 versus P2 and P3 versus P4 were 7.6% and 4.6%, respectively, corresponding to costs savings of (sic)30.5 millions and (sic)20.3 million for 10,000 patients. Conclusion: Over a 2-year period, infliximab de-escalation according to trough levels led to cost saving of about 6%, corresponding to around 25.4 million. (C) 2018 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.