A systematic review of cost-effectiveness studies comparing conventional, biological and surgical interventions for inflammatory bowel disease.

Détails

Ressource 1Télécharger: BIB_1B440642AE90.pdf (1335.54 [Ko])
Etat: Public
Version: Final published version
ID Serval
serval:BIB_1B440642AE90
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
A systematic review of cost-effectiveness studies comparing conventional, biological and surgical interventions for inflammatory bowel disease.
Périodique
PloS one
Auteur(s)
Pillai N., Dusheiko M., Burnand B., Pittet V.
ISSN
1932-6203 (Electronic)
ISSN-L
1932-6203
Statut éditorial
Publié
Date de publication
2017
Peer-reviewed
Oui
Volume
12
Numéro
10
Pages
e0185500
Langue
anglais
Notes
Publication types: Journal Article ; Review
Publication Status: epublish
Résumé
Inflammatory bowel disease (IBD) is a chronic disease placing a large health and economic burden on health systems worldwide. The treatment landscape is complex with multiple strategies to induce and maintain remission while avoiding long-term complications. The extent to which rising treatment costs, due to expensive biologic agents, are offset by improved outcomes and fewer hospitalisations and surgeries needs to be evaluated. This systematic review aimed to assess the cost-effectiveness of treatment strategies for IBD.
A systematic literature search was performed in March 2017 to identify economic evaluations of pharmacological and surgical interventions, for adults diagnosed with Crohn's disease (CD) or ulcerative colitis (UC). Costs and incremental cost-effectiveness ratios (ICERs) were adjusted to reflect 2015 purchasing power parity (PPP). Risk of bias assessments and a narrative synthesis of individual study findings are presented.
Forty-nine articles were included; 24 on CD and 25 on UC. Infliximab and adalimumab induction and maintenance treatments were cost-effective compared to standard care in patients with moderate or severe CD; however, in patients with conventional-drug refractory CD, fistulising CD and for maintenance of surgically-induced remission ICERs were above acceptable cost-effectiveness thresholds. In mild UC, induction of remission using high dose mesalazine was dominant compared to standard dose. In UC refractory to conventional treatments, infliximab and adalimumab induction and maintenance treatment were not cost-effective compared to standard care; however, ICERs for treatment with vedolizumab and surgery were favourable.
We found that, in general, while biologic agents helped improve outcomes, they incurred high costs and therefore were not cost-effective, particularly for use as maintenance therapy. The cost-effectiveness of biologic agents may improve as market prices fall and with the introduction of biosimilars. Future research should identify optimal treatment strategies reflecting routine clinical practice, incorporate indirect costs and evaluate lifetime costs and benefits.

Mots-clé
Cost-Benefit Analysis, Humans, Inflammatory Bowel Diseases/therapy
Pubmed
Web of science
Open Access
Oui
Création de la notice
05/10/2017 10:28
Dernière modification de la notice
20/08/2019 12:52
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