Cost-utility of initial medical management for Crohn's disease perianal fistulae

Area of Science:

• Gastroenterology
• Health Economics
• Pharmacoeconomics

Background:

• Crohn's disease (CD) perianal fistulae represent a significant clinical challenge.
• The cost-utility of infliximab for CD perianal fistulae remains largely uncharacterized.
• Evaluating treatment strategies is crucial for optimizing patient care and resource allocation.

Purpose of the Study:

• To determine the incremental cost-utility (CU(inc)) of medical therapies for Crohn's disease (CD) perianal fistulae.
• To compare the cost-effectiveness of infliximab-based regimens against standard therapy.
• To inform clinical and economic decision-making regarding CD perianal fistula treatment.

Main Methods:

• A Markov model simulated 1-year treatment periods for Crohn's disease (CD) perianal fistula.
• Interventions included 6-mercaptopurine/metronidazole (6MP/met), infliximab plus 6MP/met (interventions I and III), and infliximab with episodic reinfusion (intervention II).
• Utilities were derived from patient and healthy individual standard gamble responses; costs were sourced from hospital billing data; sensitivity analysis addressed uncertainty.

Main Results:

• All evaluated medical therapy strategies demonstrated comparable effectiveness for treating Crohn's disease (CD) perianal fistulae.
• Infliximab-based interventions (I, II, III) were associated with higher costs compared to 6MP/met alone.
• Incremental cost-utility ratios ranged from $355,450/QALY (Intervention I) to $377,000/QALY (Intervention III).

Conclusions:

• Infliximab therapies for Crohn's disease (CD) perianal fistulae showed similar effectiveness but significantly higher costs than 6-mercaptopurine/metronidazole within a 1-year model.
• The incremental benefit of infliximab may not justify its increased cost for treating CD perianal fistulae.
• Further prospective studies directly comparing 6MP/met and infliximab are warranted to validate these cost-utility findings.