Tight control for Crohn's disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial
OBJECTIVE: To evaluate the cost-effectiveness of an inflammatory biomarker and clinical symptom directed tight control strategy (TC) compared with symptom-based clinical management (CM) in patients with Crohn's disease (CD) naïve to immunosuppressants and biologics using a UK public payer persp...
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| Veröffentlicht in: | GUT 2020-04, Vol.69 (4), p.658-664 |
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| creator | Panaccione, Remo Colombel, Jean-Frederic Travis, Simon P.L Bossuyt, Peter Baert, Filip Vanasek, Tomas Danalioglu, Ahmet Novacek, Gottfried Armuzzi, Alessandro Reinisch, Walter Johnson, Scott Buessing, Marric Neimark, Ezequiel Petersson, Joel Lee, Wan-Ju D'Haens, Geert R |
| description | OBJECTIVE: To evaluate the cost-effectiveness of an inflammatory biomarker and clinical symptom directed tight control strategy (TC) compared with symptom-based clinical management (CM) in patients with Crohn's disease (CD) naïve to immunosuppressants and biologics using a UK public payer perspective. DESIGN: A regression model estimated weekly CD Activity Index (CDAI)-based transition matrices (remission: CDAI |
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| fullrecord | <record><control><sourceid>kuleuven</sourceid><recordid>TN_cdi_kuleuven_dspace_123456789_676495</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>123456789_676495</sourcerecordid><originalsourceid>FETCH-kuleuven_dspace_123456789_6764953</originalsourceid><addsrcrecordid>eNqVjLtOw0AQRbcgEiHhH6ZLgSyt4zcdskAUpHNvTezZeMN6F3nGgYZ_x0J8AKmudHTOvVFrreMiyoq0ulV3zGetdVlW8Vp9N_Y0CHTByxQcmDBBPYXB7xh6y4RM8GllAOzR2XEe8RgdF9iDTIQykhewvOQsERlDndgLPQJ6oOUyjLYDZCbmXzMYkIGgfno7LL1Ft1Urg47p_m83avfy3NSv0fvsaL6Qb3v-wI7aeJ-kWV6UVZsXeVplyTXmw__MVr4k-QFFJl1Z</addsrcrecordid><sourcetype>Institutional Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Tight control for Crohn's disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial</title><source>Open Access: PubMed Central</source><source>Lirias (KU Leuven Association)</source><creator>Panaccione, Remo ; Colombel, Jean-Frederic ; Travis, Simon P.L ; Bossuyt, Peter ; Baert, Filip ; Vanasek, Tomas ; Danalioglu, Ahmet ; Novacek, Gottfried ; Armuzzi, Alessandro ; Reinisch, Walter ; Johnson, Scott ; Buessing, Marric ; Neimark, Ezequiel ; Petersson, Joel ; Lee, Wan-Ju ; D'Haens, Geert R</creator><creatorcontrib>Panaccione, Remo ; Colombel, Jean-Frederic ; Travis, Simon P.L ; Bossuyt, Peter ; Baert, Filip ; Vanasek, Tomas ; Danalioglu, Ahmet ; Novacek, Gottfried ; Armuzzi, Alessandro ; Reinisch, Walter ; Johnson, Scott ; Buessing, Marric ; Neimark, Ezequiel ; Petersson, Joel ; Lee, Wan-Ju ; D'Haens, Geert R</creatorcontrib><description>OBJECTIVE: To evaluate the cost-effectiveness of an inflammatory biomarker and clinical symptom directed tight control strategy (TC) compared with symptom-based clinical management (CM) in patients with Crohn's disease (CD) naïve to immunosuppressants and biologics using a UK public payer perspective. DESIGN: A regression model estimated weekly CD Activity Index (CDAI)-based transition matrices (remission: CDAI <150, moderate: CDAI ≥150 to <300, severe: CDAI ≥300 to <450, very severe: CDAI ≥450) based on the Effect of Tight Control Management on Crohn's Disease (CALM) trial. A regression predicted hospitalisations. Health utilities and costs were applied to health states. Work productivity was monetised and included in sensitivity analyses. Remission rate, CD-related hospitalisations, adalimumab injections, other direct medical costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated. RESULTS: Over 48 weeks, TC was associated with a higher clinical remission (CDAI <150) rate (58.2% vs 46.8%), fewer CD-related hospitalisations (0.124 vs 0.297 events per patient) and more injections of adalimumab (40 mg sc) (mean 31.0 vs 24.7) than CM. TC was associated with 0.032 higher QALYs and £593 higher total medical costs. The ICER was £18 656 per QALY. The ICER was cost-effective in 57.9% of simulations. TC became dominant, meaning less costly but more effective, when work productivity was included. CONCLUSION: A TC strategy as used in the CALM trial is cost-effective compared with CM. Incorporating costs related to work productivity increases the economic value of TC. Cross-national inferences from this analysis should be made with caution given differences in healthcare systems. TRIAL REGISTRATION NUMBER: NCT01235689; Results.</description><identifier>ISSN: 0017-5749</identifier><language>eng</language><publisher>BMJ PUBLISHING GROUP</publisher><ispartof>GUT, 2020-04, Vol.69 (4), p.658-664</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,315,780,784,27860</link.rule.ids></links><search><creatorcontrib>Panaccione, Remo</creatorcontrib><creatorcontrib>Colombel, Jean-Frederic</creatorcontrib><creatorcontrib>Travis, Simon P.L</creatorcontrib><creatorcontrib>Bossuyt, Peter</creatorcontrib><creatorcontrib>Baert, Filip</creatorcontrib><creatorcontrib>Vanasek, Tomas</creatorcontrib><creatorcontrib>Danalioglu, Ahmet</creatorcontrib><creatorcontrib>Novacek, Gottfried</creatorcontrib><creatorcontrib>Armuzzi, Alessandro</creatorcontrib><creatorcontrib>Reinisch, Walter</creatorcontrib><creatorcontrib>Johnson, Scott</creatorcontrib><creatorcontrib>Buessing, Marric</creatorcontrib><creatorcontrib>Neimark, Ezequiel</creatorcontrib><creatorcontrib>Petersson, Joel</creatorcontrib><creatorcontrib>Lee, Wan-Ju</creatorcontrib><creatorcontrib>D'Haens, Geert R</creatorcontrib><title>Tight control for Crohn's disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial</title><title>GUT</title><description>OBJECTIVE: To evaluate the cost-effectiveness of an inflammatory biomarker and clinical symptom directed tight control strategy (TC) compared with symptom-based clinical management (CM) in patients with Crohn's disease (CD) naïve to immunosuppressants and biologics using a UK public payer perspective. DESIGN: A regression model estimated weekly CD Activity Index (CDAI)-based transition matrices (remission: CDAI <150, moderate: CDAI ≥150 to <300, severe: CDAI ≥300 to <450, very severe: CDAI ≥450) based on the Effect of Tight Control Management on Crohn's Disease (CALM) trial. A regression predicted hospitalisations. Health utilities and costs were applied to health states. Work productivity was monetised and included in sensitivity analyses. Remission rate, CD-related hospitalisations, adalimumab injections, other direct medical costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated. RESULTS: Over 48 weeks, TC was associated with a higher clinical remission (CDAI <150) rate (58.2% vs 46.8%), fewer CD-related hospitalisations (0.124 vs 0.297 events per patient) and more injections of adalimumab (40 mg sc) (mean 31.0 vs 24.7) than CM. TC was associated with 0.032 higher QALYs and £593 higher total medical costs. The ICER was £18 656 per QALY. The ICER was cost-effective in 57.9% of simulations. TC became dominant, meaning less costly but more effective, when work productivity was included. CONCLUSION: A TC strategy as used in the CALM trial is cost-effective compared with CM. Incorporating costs related to work productivity increases the economic value of TC. Cross-national inferences from this analysis should be made with caution given differences in healthcare systems. 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DESIGN: A regression model estimated weekly CD Activity Index (CDAI)-based transition matrices (remission: CDAI <150, moderate: CDAI ≥150 to <300, severe: CDAI ≥300 to <450, very severe: CDAI ≥450) based on the Effect of Tight Control Management on Crohn's Disease (CALM) trial. A regression predicted hospitalisations. Health utilities and costs were applied to health states. Work productivity was monetised and included in sensitivity analyses. Remission rate, CD-related hospitalisations, adalimumab injections, other direct medical costs, quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratio (ICER) were calculated. RESULTS: Over 48 weeks, TC was associated with a higher clinical remission (CDAI <150) rate (58.2% vs 46.8%), fewer CD-related hospitalisations (0.124 vs 0.297 events per patient) and more injections of adalimumab (40 mg sc) (mean 31.0 vs 24.7) than CM. TC was associated with 0.032 higher QALYs and £593 higher total medical costs. The ICER was £18 656 per QALY. The ICER was cost-effective in 57.9% of simulations. TC became dominant, meaning less costly but more effective, when work productivity was included. CONCLUSION: A TC strategy as used in the CALM trial is cost-effective compared with CM. Incorporating costs related to work productivity increases the economic value of TC. Cross-national inferences from this analysis should be made with caution given differences in healthcare systems. TRIAL REGISTRATION NUMBER: NCT01235689; Results.</abstract><pub>BMJ PUBLISHING GROUP</pub><oa>free_for_read</oa></addata></record> |
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| title | Tight control for Crohn's disease with adalimumab-based treatment is cost-effective: an economic assessment of the CALM trial |
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