Continuing Medical Education Questions: August 2021

Area of Science:

• Gastroenterology
• Health Economics
• Computational Modeling

Background:

• Crohn's disease requires long-term management, often involving significant healthcare costs.
• Current treatment strategies aim to achieve clinical remission but optimal approaches are debated.
• The economic impact of managing Crohn's disease necessitates efficient treatment paradigms.

Purpose of the Study:

• To develop and validate a microsimulation model for assessing treatment strategies in Crohn's disease.
• To determine the cost-effectiveness of "treat to target" (TTT) approaches compared to standard care.
• To provide an economic framework for optimizing therapeutic decisions in Crohn's disease management.

Main Methods:

• Development of a discrete-event microsimulation model simulating individual patient journeys.
• Inclusion of disease progression, treatment efficacy, adverse events, and healthcare costs.
• Comparison of TTT strategies (e.g., escalating therapy based on predefined targets) versus conventional management.

Main Results:

• The TTT strategies were found to be cost-effective over a lifetime horizon.
• TTT approaches led to improved clinical outcomes, such as sustained remission and reduced complications.
• The model identified specific TTT thresholds that maximized both clinical benefit and economic value.

Conclusions:

• Microsimulation modeling is a robust tool for evaluating complex treatment strategies in Crohn's disease.
• "Treat to target" strategies represent a cost-effective approach to managing Crohn's disease, improving patient outcomes.
• Economic evaluations using such models can guide clinical practice and healthcare policy for Crohn's disease.