P254. Effect of standard treatment (ST) versus episodic (ET) or maintenance (MT) infliximab on healthcare cost (HC) and quality-adjusted life years (QALYs) in a community-based incidence cohort of adult Crohn's disease patients with 10
S. Odes1, H. Vardi2, D. Greenberg3, M. Friger2, R. Stockbrugger4, B. Moum5, C. O'Morain6, E. Langholz7, P. Munkholm8
1Soroka University Hospital and Ben Gurion University of The Negev, Department of Gastroenterology an Hepatology, Beer-Sheva, Israel; 2Ben Gurion University of the Negev, Epidemiology, Beer Sheva, Israel; 3Ben Gurion University of the Negev, Health Systems Management, Beer Sheva, Israel; 4Maastricht University Hospital, Gastroenterology and Hepatology, Maastricht, Netherlands; 5Oslo University Hospital, Department of Gastroenterology, Oslo, Norway; 6Adelaide & Meath Hospital, Gastroenterology, Dublin, Ireland; 7Gentofte Hospital, Gastrienterology Section, Hellerup, Denmark; 8Herlev University Hospital, Department of Gastroenterology, Copenhagen, Denmark
Background: Infliximab (IFX) induces and maintains remission in Crohn's disease (CD) but its impact on HC and QALY is incompletely understood. This issue is best studied incorporating current strategies of IFX use into real patient data.
Methods: 212 incident adult CD patients (age at disease onset 34.4±14.5 y, 49.9% male) treated with ST (antibiotics, mesalazine, steroids, thiopurines, surgery) had precise HC data recorded in 3 month-cycles over 10 years up to 2004. In ST eight health states were defined by intensity of medical therapy and surgery. Markov transition probabilities between cycles and HC per state were calculated. This cohort was then modeled to allow drug refractory or pre-surgery patients to receive IFX, either episodically (ET) in one cycle or as maintenance (MT) in responders for multiple cycles. For ET and MT the states IFX for refractory and IFX for requiring surgery were created. The transition probabilities of ST were applied to patients receiving IFX, and the probability of continuing IFX in MT was set at 0.989 to correct for decay. HC and QALYs in ET and MT were estimated for 10 years and compared with ST. Costs were discounted 3% per annum.
Results: IFX was given in 441 cycles in ET, 5404 cycles in MT. Drug-refractory cycles totaled 1690 in ST, 77 in ET, 3 in MT. Surgery cycles were 65 in ST, 9 in ET, 0 in MT. HC/patient/10 years in Euros were: ST 23,224, ET 22,312 and MT 56,516. From year 2 HC was steady in all treatments but 2.43X higher in MT.
QALYs were significantly different, with 10 year totals/patient of 91.88 in ST, 96.47 in ET and 99.54 in MT.
Conclusions: MT was the most expensive but gave the highest QALYs, whereas ET achieved more QALYs than ST for the same cost. These data will be useful in planning budgets for CD patients requiring IFX where resources are limited.