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News

Test-based strategy vs empiric dose escalation in unresponsive Crohn's disease

A study in the latest issue of Clinical Gastroenterology & Hepatology reports that a test-based strategy is more cost effective than empiric dose escalation for patients with Crohn's disease who lose responsiveness to infliximab.

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Patients with Crohn's disease who become unresponsive to therapy with tumor necrosis factor antagonists are managed initially with either empiric dose escalation or testing-based strategies.

The comparative cost effectiveness of these 2 strategies is unknown.

Dr Fernando Velayos from California, USA investigated whether a testing-based strategy is more cost effective than an empiric dose-escalation strategy.

The researchers compared 2 cohorts of patients with Crohn's disease evaluating the outcomes for the 2 strategies over a 1-year time period.

The research team assessed that the incremental cost-effectiveness ratio of the empiric strategy was expressed as cost per quality-adjusted life-year gained, compared with the testing-based strategy.

The team performed a 1-way, probabilistic, and prespecified secondary analyses.

Cost-effectiveness ratio of the empiric strategy ranged to more than $5 million per quality-adjusted life-year gained
Clinical Gastroenterology and Hepatology

The team of doctors reported that the testing strategy yielded similar quality-adjusted life-year compared with the empiric strategy but was less expensive.

In sensitivity analyses, the incremental cost-effectiveness ratio of the empiric strategy ranged from $500,000 to more than $5 million per quality-adjusted life-year gained.

The researchers observed that similar rates of remission and response were achieved through differential use of available interventions.

The testing-based strategy resulted in a higher percentage of surgeries and lower percentage use of high-dose biological therapy.

Dr Velayos's team commented, "A testing-based strategy is a cost-effective alternative to the current strategy of empiric dose escalation for managing patients with Crohn's disease who have lost responsiveness to infliximab."

"The basis for this difference is lower cost at similar outcomes."

Clin Gastroenterol and Hepatol 2013: 11(6): 654-666
28 June 2013

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