Table 2. Cost-effectiveness of biologics for the treatment of Crohn’s disease (CD).
| Study | Intervention (Biologic treatment) | Comparison treatment | ICER a € d /QALY (including only direct b costs) | ICER a € d /QALY (including both direct b and indirect c costs) | Results of deterministic sensitivity analysis (€ d /QALY) | Source of research funding |
|---|---|---|---|---|---|---|
| Cost-effectiveness of biologics in CD patients with no previous treatment | ||||||
| Arseneau et al. 2001 [41] | First-line IFX | 6MP+MET | 438,617 | - | 219,353–dominance by comparison treatment | NIDDK |
| IFX episodic reinfusion | 6MP+MET | 445,477 | - | 127,314–dominance by comparison treatment | NIDDK | |
| Second-line IFX episodic reinfusion | 6MP+MET | 465,394 | - | 155,109–comparison treatment is cost-saving | NIDDK | |
| Marchetti et al. 2013 [50] | Top-down: IFX | Step-up: IFX | Dominance by intervention treatment | - | Dominance by intervention treatment–93,401 | None declared |
| Cost-effectiveness of biologics in CD patients with earlier conventional medical treatment | ||||||
| Assasi et al. 2009 [22] | IFX | Conventional medical treatment | 155,295 | - | 142,742–254,029 | Canadian federal, provincial, and territorial governments |
| ADA | Conventional medical treatment | 134,643 | - | 120,307–474,352 | Canadian federal, provincial, and territorial governments | |
| IFX | ADA | 314,250 | - | 154,436–Dominance by comparison treatment | Canadian federal, provincial, and territorial governments | |
| Blackhouse et al. 2012 [42] | IFX | Conventional medical treatment | 164,626 | - | 74,434–344,212 | Not stated, one of authors has received an honorarium from Abbott and acted as a consultant for Centocor Ortho Biotech Services |
| ADA | Conventional medical treatment | 142,733 | - | 63,679–297,508 | Not stated, one of authors has received an honorarium from Abbott and acted as a consultant for Centocor Ortho Biotech Services | |
| IFX | ADA | 331,132 | - | 157,253–Dominance by comparison treatment | Not stated, one of authors has received an honorarium from Abbott and acted as a consultant for Centocor Ortho Biotech Services | |
| Bodger et al. 2009 [43] | IFX | Conventional treatment | 31,982 (Duration of treatment 1 year); 35,759 (Duration of treatment 2 years) | - | 31,227–Dominance by comparison treatment | The Welsh Office for Research and Development for Health and Social Care |
| ADA | Conventional treatment | 12,071 (Duration of treatment 1 year); 17,309 (Duration of treatment 2 years) | - | 12,692–304,912 | The Welsh Office for Research and Development for Health and Social Care | |
| Clark et al. 2003 [44] | IFX single dose | Placebo | a) 11,725 b) 236,836 (scenario 1) 163,179 (scenario 2) c) 178,503–215,253 | - | b) 236,836–529,754 (scenario 1); 163,179–373,921 (scenario 2) c) 143,502–215,253 | NICE (UK) |
| IFX episodic re-treatment if lost response | Placebo | a) 18,200 b) 126,459 (scenario 1); 108,530 (scenario 2) | - | a) 34,651–95,901 b) 82,197–126,459 (scenario 1); 70,544–108,530 (scenario 2) | NICE (UK) | |
| IFX maintenance treatment | Placebo | a) 147,702 | - | - | NICE (UK) | |
| Dreztke et al. 2011 [21] | IFX induction treatment | Conventional medical treatment | Dominance by intervention treatment (Severe CD); 162,941 (Moderate CD) | - | 17,346–123,198 | NICE (UK) |
| IFX maintenance treatment | Conventional medical treatment | 118,015 (Severe CD); 549,335 (Moderate CD) | - | 63,127–2,764,027 | NICE (UK) | |
| ADA induction treatment | Conventional medical treatment | Dominance by intervention treatment | - | Dominance by intervention treatment | NICE (UK) | |
| ADA maintenance treatment | Conventional medical treatment | 13,387 (Severe CD); 276,539 (Moderate CD) | - | Dominance by intervention treatment–1,180,345 | NICE (UK) | |
| IFX maintenance treatment | IFX induction treatment | 8,689,409 (Severe CD); 24,012,483 (Moderate CD) | - | 553,635–8,568,483 | NICE (UK) | |
| ADA maintenance treatment | ADA induction treatment | 8,603,033 (Severe CD); 24,012,483 (Moderate CD) | - | Dominance by intervention treatment–8,810,335 | NICE (UK) | |
| Jaisson-Hot et al. 2004 [46] | IFX re-treatment | Surgery | 77,002 | - | 77,002–dominance by comparison treatment | Not stated |
| IFX maintenance treatment | Surgery | 947,769 | - | 947,769–dominance by comparison treatment | Not stated | |
| Lindsay et al. 2008 [48] | IFX | Conventional medical treatment | 45,137 (Severe active luminal CD); 51,397 (Fistulizing CD) | - | 41,032–67,111 (Severe active luminal CD); 46,724–76,367 (Fistulizing CD) | Schering Plough Ltd |
| Loftus et al. 2009 [49] | ADA | Conventional medical treatment | 27,751 (Severe CD); 58,271 (Moderate-to-severe CD) | 9,069 (Severe CD); 42,554 (Moderate-to-severe CD) | 11,315–59,133 (Severe CD); 30,876–99,455 (Moderate-to-severe CD) | Abbott Laboratories |
| Marshall et al. 2002 [19] | IFX single dose | Conventional treatment | 162,181 | - | 34,908–Dominance by comparison treatment | CCOHTA (now CADTH) |
| IFX single dose with re-treatment | IFX single dose | 429,715 | - | Dominance by intervention treatment–533,605 | CCOHTA (now CADTH) | |
| IFX maintenance treatment | IFX single dose with re-treatment | 623,013 | - | 1,620–736,716 | CCOHTA (now CADTH) | |
| Saito et al. 2013 [51] | IFX+AZA | IFX | 34,549 | - | 23,776–63,178 | CISA |
| Tang et al. 2012 [52] | ADA | IFX | - | - | - | Not stated |
| CTZ | IFX | - | - | - | Not stated | |
| NTZ | IFX | - | - | - | Not stated | |
| Yu et al. 2009 [56] | ADA maintenance treatment | IFX maintenance treatment | Dominance by intervention treatment | - | Dominance by intervention treatment | Abbott Laboratories |
| Cost-effectiveness of biologics in CD patients with earlier surgical treatment | ||||||
| Ananthakrishnan et al. 2011 [39] | Upfront IFX | Antibiotic | 2,268,986 | - | 594,301–5,485,175 | None declared, one author receives research support from Procter and Gamble and Warner Chilcott |
| Tailored IFX | Antibiotic | Dominance by comparison treatment | Dominancy by comparison treatment | None declared, one author receives research support from Procter and Gamble and Warner Chilcott | ||
| Doherty et al. 2012 [45] | IFX | AZA/6MP | 1,449,979 (Time horizon 1 year); 1,823,102 (Time horizon 5 years) | - | 1,449,979–Dominance by comparison treatment | Pfizer Inc. and Merck & Co. One of authors receives research funding from Proctor & Gamble, Shire and Salix |
| Cost-effectiveness of biologics in CD patients with earlier biological treatment | ||||||
| Ananthakrishnan et al. 2012 [40] | NTZ | CTZ | 314,020 | - | Dominance by intervention treatment—Dominance by comparison treatment | None declared |
| Kaplan et al. 2007 [47] | IFX dose escalation | ADA | 311,432 | - | 46,862–Dominance by comparison treatment | None declared, authors have received research grants from UCB Pharma, Abbott Laboratories, Centocor, Bristol-Myers Squibb, Elan Pharmaceuticals, Prometheus Laboratories, Otsuka America Pharmaceuticals Inc |
ADA, Adalimumab; CEGIIR, Centre of Excellence for Gastrointestinal Inflammation and Immunity Research; CST, Corticosteroid; CYC, Cyclosporine; IFX, Infliximab; IV, Intravenous; NICE, National Institute for Health and Care Excellence; RCT, Randomized controlled trial; QALY, Quality-Adjusted Life Year; TTO, Time Trade-off; VAS, Visual analog scale.
aThe difference in costs divided by the difference in health effects.
bThe resources consumed.
cProductivity costs for the patient and family members.
dAll costs converted into 2014 euro.