Abstract
Background
In Crohn’s disease patients failing infliximab therapy, interventions defined by an algorithm based on infliximab and anti-infliximab antibody measurements have proven more cost-effective than intensifying the infliximab regimen.
Aim
This study investigated long-term economic outcomes at the week 20 follow-up study visit and after 1 year. Clinical outcomes were assessed at week 20.
Methods
Follow-up from a 12-week, single-blind, clinical trial where patients with infliximab treatment failure were randomized to infliximab intensification (5 mg/kg every 4 weeks) (n = 36), or algorithm-defined interventions (n = 33). Accumulated costs, expressed as mean costs per patient, were based on the Danish National Patient Registry.
Results
At the scheduled week 20 follow-up study visit, response and remission rates were similar in all study subpopulations between patients treated by the algorithm or by infliximab intensification. However, the sum of healthcare costs related to Crohn’s disease was substantially lower (31 %) for patients randomized to algorithm-based interventions than infliximab intensification in the intention-to-treat population: $11,940 versus $17,236; p = 0.005. For per-protocol patients (n = 55), costs at the week 20 follow-up visit were even lower (49 %) in the algorithm group: $8,742 versus $17,236; p = 0.002. Figures were similar for patients having completed the 12-week trial as per protocol (50 % reduction in costs) (n = 45). Among patients continuing the allocated study intervention throughout the entire 20-week follow-up period (n = 29), costs were reduced by 60 % in algorithm-treated patients: $7,056 versus $17,776; p < 0.001. Cost-reduction percentages remained stable throughout one year.
Conclusion
Economic benefit of algorithm-based interventions at infliximab failure is maintained throughout 1 year.
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Acknowledgments
We thank the following people for their technical assistance: Hanne Fuglsang, Anne Hallander, Vibeke Hansen, Birgit Kristensen, Yvonne Krogager, Charlotte Kühnel, Lene Neergaard, Lise Olsen, Anni Petersen (Dept. of Gastroenterology, Herlev University Hospital, Denmark); Pierre Nourdine Bouchelouche and Sussi Holbæk (Dept. of Medical Gastroenterology, Køge University Hospital, Denmark); Tove Nygaard (Dept. of Medical Gastroenterology, Aalborg University Hospital, Denmark); Rikke Charlotte Andersen, Lisbet Gerdes, Catriona Nairn Marcussen, Birgitte Sperling Wilms Nielsen, and Inger Schjødt (Dept. of Hepatology and Gastroenterology V, Aarhus University Hospital), Carina Blixt (Dept. of Gastroenterology, Hvidovre University Hospital, Denmark); Anne Berg (Dept. of Medical Gastroenterology S, Odense University Hospital, Denmark). We would also wish to thank Biomonitor A/S and Prometheus Laboratories Inc. Support for this study was provided by unrestricted research grants from Aase and Ejnar Danielsen’s Foundation, Beckett Foundation, Danish Biotechnology Program, Danish Colitis-Crohn Society, Danish Medical Association Research Foundation, Frode V. Nyegaard and Wife’s Foundation, Health Science Research Foundation of Region of Copenhagen, Herlev Hospital Research Council, Lundbeck Foundation, P. Carl Petersen’s Foundation, Ole Østergaard Thomsen’s Research Foundation, and Jørn Brynskov’s Research Foundation.
Conflict of interest
C. Steenholdt has served as speaker for MSD, Abbvie, and Pfizer and as a consultant for MSD and Takeda Pharmaceutical LTD. J. Brynskov has served as advisory board member for Abbvie. OØ Thomsen has served as a speaker and consultant for UCB and Zealand Pharma; speaker for MSA; and primary investigator for Amgen, Biogen, Novo-Nordisk, and Pfizer. L.K. Munck has served as speaker for MSD and participated in a safety study with Abbvie. J. Fallingborg has served as primary investigator for Centocor, Abbvie, MSD, and UCB and as a consultant for Abbvie and MSD. L.A. Christensen has served as speaker for Abbvie, Tillotts Pharma, and Ferring and as a consultant for MSD. J. Kjeldsen has served as a speaker for MSD, Abbvie, and Tillotts. K. Bendtzen has served as a speaker for Pfizer and Biomonitor; and owns stocks in Novo-Nordisk and Biomonitor. B.A. Jacobsen has served as advisory board member at Tillots Pharma. G. Pedersen, A.S. Oxholm, J. Kjellberg, and M.A. Ainsworth have no interests to declare.
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Steenholdt, C., Brynskov, J., Thomsen, O.Ø. et al. Individualized Therapy Is a Long-Term Cost-Effective Method Compared to Dose Intensification in Crohn’s Disease Patients Failing Infliximab. Dig Dis Sci 60, 2762–2770 (2015). https://doi.org/10.1007/s10620-015-3581-4
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DOI: https://doi.org/10.1007/s10620-015-3581-4