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P577. Cost-effectiveness of episodic or maintenance infliximab versus standard treatment in an incidence cohort of Crohn's disease patients with 10-years follow-up

S. Odes1, D. Greenberg2, H. Vardi3, M. Friger3, R. Stockbrugger4, P. Munkholm5, 1Soroka Medical Center and Ben Gurion University of the Negev, Gastorenterology and Hepatology, Beer Sheva, Israel, 2Ben Gurion University of the Negev, Health Systems Management, Beer Sheva, Israel, 3Ben Gurion University of the Negev, Epidemiology, Beer Sheva, Israel, 4Maastricht University Hospital, Gastroenterology and Hepatology, Maastricht, Netherlands, 5University of Copenhagen and Herlev Hospital, Gastroenterology, Copenhagen, Denmark

Background

Infliximab is indicated in Crohn's disease resistant to standard treatment with antibiotics, mesalazine, corticosteroids and immunomodulators), and was shown to reduce the need for hospitalization and surgery. Whether this is enough to offset its high acquisition price is unknown, and the impact of infliximab on healthcare-cost and quality-adjusted life-expectancy is incompletely understood. Previous studies using mathematical models failed to demonstrate cost savings. We sought to determine the cost-effectiveness of infliximab in a real life cohort of Crohn's disease patients, using episodic and maintenance infliximab treatment and calculating their cost-effectiveness versus standard treatment and versus each other.

Methods

212 incident adult CD patients (age at onset 34.4±14.5 years, 49.4% male) had received standard treatment over 10-years to 2004. We defined 8 health states (by intensity of treatment) and their Markov transition probabilities, healthcare costs and quality-adjusted life years (QALYs) in 3-month-cycles. The cohort was modeled to allow infliximab treatment as episodic treatment (one cycle) or maintenance treatment for 1-year (MT-1yr) or 10-years (MT-10yr), using current clinical criteria for biologic treatment. Healthcare-cost (3% discount) and QALYs in episodic treatment and maintenance treatment were estimated for 10-years and compared with standard treatment and with each other.

Results

The average cost in EUROS (QALYs gained) per patient over 10-years was 23,169 (6.7014) for standard treatment; 21,691 (7.0403) for episodic treatment, 29,012 (7.0553) for MT-1yr, and 50,416 (7.2603) for MT-10 yr. Standard treatment was dominated by episodic treatment. The incremental cost-effectiveness ratios (ICERs) of MT-1yr or MT-10 yr over standard treatment were 16,510/QALY or 48,751/QALY. When compared with episodic treatment, the ICERs of MT-1yr and MT-10 yrs were 488,066/QALY, and 130,568/QALY, respectively.

Conclusion

Episodic treatment or maintenance treatment with infliximab are either cost-saving or cost-effective when compared with standard treatment. However, at current drug prices, maintenance treatment does not provide good value for money when compared with episodic treatment. Reduction of the price of infliximab will serve to alter this finding.