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Bouhnik Y, Atreya R, Casey D, Górecki M, Baik D, Yoon SW, Kwon TS, Jang M. Cost-effectiveness Analysis of Subcutaneous Infliximab for Inflammatory Bowel Diseases in Sequential Biologic Treatment. Inflamm Bowel Dis 2022:6658536. [PMID: 35942647 DOI: 10.1093/ibd/izac160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Indexed: 12/09/2022]
Abstract
BACKGROUND Inflammatory bowel disease (IBD) guidelines recommend tumor necrosis factor-α inhibitors (TNFis) for patients who have not responded to conventional therapy, and vedolizumab in case of inadequate response to conventional therapy and/or TNFis. Recent studies have shown that vedolizumab may also be effective in the earlier treatment lines. Therefore, we conducted cost-effectiveness analyses to determine the optimal treatment sequence in patients with IBD. METHODS A Markov model with a 10-year time horizon compared the cost-effectiveness of different biologic treatment sequences in patients with moderate to severe ulcerative colitis (UC) and Crohn's disease (CD) from the UK and French perspectives. Subcutaneous formulations of infliximab, vedolizumab, and adalimumab were evaluated. Comparative effectiveness was based on a network meta-analysis of clinical trials and real-world evidence. Costs included pharmacotherapy, surgery, adverse events, and disease management. RESULTS The results indicated that treatment sequences starting with infliximab were less costly and more effective than those starting with vedolizumab for patients with UC in the United Kingdom and France, and patients with just CD in France. For patients with CD in the United Kingdom, treatment sequences starting with infliximab resulted in better health outcomes with incremental cost-effectiveness ratios (ICERs) near the threshold. CONCLUSIONS Based on the ICERs, treatment sequences starting with infliximab are the dominant option for patients with UC in the United Kingdom, and patients with UC and CD in France. In UK patients with CD, ICERs were near the assumed "willingness to pay" threshold. These results reinforce the UK's National Institute for Health and Care Excellence recommendations for using infliximab prior to using vedolizumab in biologics-naïve patients.
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Affiliation(s)
- Yoram Bouhnik
- Beaujon Hospital, Department of Gastroenterology, Paris University, Clichy, France
| | - Raja Atreya
- Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Daniel Casey
- Celltrion Healthcare United Kingdom Limited, Slough, United Kingdom
| | | | - Deborah Baik
- Celltrion Healthcare Co., Ltd., Incheon, Republic of Korea
| | - Sang Wook Yoon
- Celltrion Healthcare Co., Ltd., Incheon, Republic of Korea
| | - Taek Sang Kwon
- Celltrion Healthcare Co., Ltd., Incheon, Republic of Korea
| | - Minyoung Jang
- Celltrion Healthcare Co., Ltd., Incheon, Republic of Korea
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Coffey CJ, Kiernan MG, Sahebally SM, Jarrar A, Burke JP, Kiely PA, Shen B, Waldron D, Peirce C, Moloney M, Skelly M, Tibbitts P, Hidayat H, Faul PN, Healy V, O’Leary PD, Walsh LG, Dockery P, O’Connell RP, Martin ST, Shanahan F, Fiocchi C, Dunne CP. Inclusion of the Mesentery in Ileocolic Resection for Crohn's Disease is Associated With Reduced Surgical Recurrence. J Crohns Colitis 2018; 12:1139-1150. [PMID: 29309546 PMCID: PMC6225977 DOI: 10.1093/ecco-jcc/jjx187] [Citation(s) in RCA: 195] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS Inclusion of the mesentery during resection for colorectal cancer is associated with improved outcomes but has yet to be evaluated in Crohn's disease. This study aimed to determine the rate of surgical recurrence after inclusion of mesentery during ileocolic resection for Crohn's disease. METHODS Surgical recurrence rates were compared between two cohorts. Cohort A [n = 30] underwent conventional ileocolic resection where the mesentery was divided flush with the intestine. Cohort B [n = 34] underwent resection which included excision of the mesentery. The relationship between mesenteric disease severity and surgical recurrence was determined in a separate cohort [n = 94]. A mesenteric disease activity index was developed to quantify disease severity. This was correlated with the Crohn's disease activity index and the fibrocyte percentage in circulating white cells. RESULTS Cumulative reoperation rates were 40% and 2.9% in cohorts A and B [P = 0.003], respectively. Surgical technique was an independent determinant of outcome [P = 0.007]. Length of resected intestine was shorter in cohort B, whilst lymph node yield was higher [12.25 ± 13 versus 2.4 ± 2.9, P = 0.002]. Advanced mesenteric disease predicted increased surgical recurrence [Hazard Ratio 4.7, 95% Confidence Interval: 1.71-13.01, P = 0.003]. The mesenteric disease activity index correlated with the mucosal disease activity index [r = 0.76, p < 0.0001] and the Crohn's disease activity index [r = 0.70, p < 0.0001]. The mesenteric disease activity index was significantly worse in smokers and correlated with increases in circulating fibrocytes. CONCLUSIONS Inclusion of mesentery in ileocolic resection for Crohn's disease is associated with reduced recurrence requiring reoperation.
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Affiliation(s)
- Calvin J Coffey
- Department of Surgery, University Hospital Limerick, Limerick, Ireland,Graduate Entry Medical School, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation and Immunity [4i], University of Limerick, Limerick, Ireland,Corresponding author: Professor J. Calvin Coffey, PhD, FRCSI, Surgical Professorial Unit, University Hospital Limerick, Limerick, Ireland. Tel.: +353-61-482412; fax: +353-61-482410;
| | - Miranda G Kiernan
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation and Immunity [4i], University of Limerick, Limerick, Ireland
| | - Shaheel M Sahebally
- Department of Surgery, University Hospital Limerick, Limerick, Ireland,Graduate Entry Medical School, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation and Immunity [4i], University of Limerick, Limerick, Ireland
| | - Awad Jarrar
- Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - John P Burke
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
| | - Patrick A Kiely
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation and Immunity [4i], University of Limerick, Limerick, Ireland,Health Research Institute [HRI], University of Limerick, Limerick, Ireland
| | - Bo Shen
- Lerner College of Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA,Departments of Gastroenterology/Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - David Waldron
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - Colin Peirce
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - Manus Moloney
- Department of Gastroenterology, University Hospitals Limerick, Limerick, Ireland
| | - Maeve Skelly
- Department of Gastroenterology, University Hospitals Limerick, Limerick, Ireland
| | - Paul Tibbitts
- Department of Surgery, University Hospital Limerick, Limerick, Ireland,Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Hena Hidayat
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - Peter N Faul
- Department of Pathology, University Hospitals Limerick, Limerick, Ireland
| | - Vourneen Healy
- Department of Pathology, University Hospitals Limerick, Limerick, Ireland
| | - Peter D O’Leary
- Department of Surgery, University Hospital Limerick, Limerick, Ireland
| | - Leon G Walsh
- Department of Surgery, University Hospital Limerick, Limerick, Ireland,Graduate Entry Medical School, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation and Immunity [4i], University of Limerick, Limerick, Ireland
| | - Peter Dockery
- Department of Anatomy, National University of Ireland Galway, Galway, Ireland
| | - Ronan P O’Connell
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin, Ireland,School of Medicine, University College Dublin, Dublin, Ireland
| | - Sean T Martin
- Centre for Colorectal Disease, St Vincent’s University Hospital, Dublin, Ireland
| | - Fergus Shanahan
- Department of Medicine, Alimentary Pharmabiotic Centre, University College Cork, Cork, Ireland
| | - Claudio Fiocchi
- Departments of Gastroenterology/Hepatology, Digestive Disease and Surgery Institute, Cleveland Clinic Foundation, Cleveland, OH, USA,Department of Pathobiology, Lerner Research Institute, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Colum P Dunne
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland,Centre for Interventions in Infection, Inflammation and Immunity [4i], University of Limerick, Limerick, Ireland
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