An economic évaluation of inflammatory bowel disease using real world data in Switzerland


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PhD thesis: a PhD thesis.
An economic évaluation of inflammatory bowel disease using real world data in Switzerland
Pittet  Valérie
Dusheiko  Mark
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Université de Lausanne, Faculté de biologie et médecine
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Inflammatory bowel disease (IBD), consisting primarily of Crohn’s disease (CD) and ulcerative colitis (UC), is a chronic condition of the gastrointestinal tract placing a large health and economic burden on health systems worldwide. Increased availability of biologic agents have shown promise to improve health outcomes and reduce the need for steroids and surgery; however, the long-term clinical and cost implications of their use needs to be determined. This thesis aimed to evaluate the costs and cost- effectiveness associated with novel pharmaceuticals for the treatment of adults diagnosed with IBD in Switzerland. Studies in this thesis draw on statistical and econometric methods to evaluate real world data obtained from the Swiss IBD Cohort Study (SIBDCS) and reimbursement claims.
In Switzerland, the economic burden of CD and UC was demonstrated with mean health care costs estimated at CHF 10,553 for CD and CHF 6,334 for UC per patient per year. Between 2006 and 2016, expenditures rose by 7% for CD and 10% for UC per year, on average, due to a rapid uptake of biologic agents. Moreover, expenditures on inpatient and outpatient events, and indirect costs associated with work absenteeism remained stable during this period. This study points to an important shift in the clinical management of IBD towards greater use of pharmaceuticals.
Early aggressive treatment with biologic agents has been suggestedas a novel strategy to help achieve long-term mucosal healing and modify the natural course of CD. This thesis showed that CD patients treated with biologics within 2 years of diagnosis (early biologic treatment) did not experience significant improvements in disease progression or surgery rates over 10 years when compared to similar patients who did not receive biologics or received biologics >2 years after diagnosis (late/no biologic treatment). Moreover, early compared to late or no biologic treatment was associated with high lifetime costs (CHF 384,607 versus CHF 340,800) and minor improvements in quality-adjusted life years (QALYs: 16.84 versus 16.75) and was therefore not cost-effective with incremental cost-effectiveness ratios (ICERs) above acceptable thresholds from the Swiss health system (CHF 887,450 per QALY) and societal perspectives (CHF 449,130 per QALY). However, in a subgroup of patients known to receive biologic treatments during the course of their disease, earlier initiation improved clinicaloutcomes and was cost- effective compared to late initiation. In addition, future price reductions from biosimilars may help contain rising costs in IBD and improve the cost-effectiveness of early biologic treatment approaches.
This thesis highlights the need to identify characteristics influencing disease prognosis for IBD patients in order to stratify patients and target aggressive treatment strategies to those likely to benefit. Moreover, closer monitoring of patients’ response to treatments will help timely decision-making and improve the efficiency of patient care. More generally, this work contributes to the ongoing development of methods to use real world data to evaluate long-term health outcomes and cost-effectiveness and highlights the importance of continuous evaluation of the cost-effectiveness of novel pharmaceuticals to ensure value for money in the health system.
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07/02/2020 11:53
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10/03/2020 10:42
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