Health-economic analysis: Cost-effectiveness of scheduled maintenance treatment with infliximab for Crohn's disease - Modelling outcomes in active luminal and fistulizing disease in adults

Abstract

Background: Infliximab has been shown to be efficacious in moderate-to-severe Crohn's disease (CD). Aim: To evaluate the cost-effectiveness of scheduled maintenance treatment with infliximab in luminal and fistulizing CD patients. Methods: Markov models were constructed to simulate the progression of adult CD patients with and without fistulae during treatment with infliximab (5 mg/kg). Transitions were estimated from published clinical trials of infliximab. Standard care, comprising immunomodulators and/or corticosteroids was used as a comparator. An average weight of 60 kg was used to estimate the dose of infliximab. The costs and outcomes were discounted at 3.5% over 5 years. The primary effectiveness measurement was quality-adjusted life years (QALYs) estimated using EQ-5D. One-way and probabilistic sensitivity analyses were performed by varying the infliximab efficacy estimates, costs and utilities. Results: The incremental cost per QALY gained was £26 128 in luminal CD and £29 752 in fistulizing CD at 5 years. Results were robust and remained in the range of £23 752-£38 848 for luminal CD and £27 047-£44 206 for fistulizing CD. Patient body weight was the most important factor affecting cost-effectiveness. Conclusion: Eight-week scheduled maintenance treatment with infliximab is a cost-effective treatment for adult patients suffering from active luminal or fistulizing CD. © 2008 Schering-Plough Corp.