Therapeutic drug monitoring of anti-TNF is increasingly used to manage inflammatory bowel diseases (IBD) and rheumatoid arthritis.
The cost-effectiveness of this strategy is debated.
Professor Laurent Peyrin-Biroulet and colleagues from France screened all studies comparing the cost-effectiveness of a therapeutic drug monitoring-based strategy, and an empirical dose management of anti-TNF in IBD or rheumatoid arthritis.
Studies were identified through the MEDLINE electronic database, and annual international meeting abstracts were also manually reviewed.
The research team evaluated 7 studies, including 2 randomized controlled trials enrolling 332 patients, and 5 modeling approaches.
|A therapeutic drug monitoring strategy led to major cost savings, of up to 34%|
|Journal of Gastroenterology|
The team identified 4 studies that included only CD patients, 1 that included both CD and UC patients, and 2 that included only rheumatoid arthritis patients.
The researchers found that 3 studies compared the cost-effectiveness of the 2 strategies in patients with secondary infliximab failure, 1 in patients in remission on optimized infliximab, 1 in patients starting adalimumab, and 2 in patients with clinical response to maintenance anti-TNF therapy.
The 2 randomized controlled trials demonstrated that a therapeutic drug monitoring strategy led to major cost savings, ranging from 28% to 34%.
The 3 modeling approaches with regard to CD patients demonstrated cost savings ranging from $5396 over a 1-year period to €13,130 per patient at 5 years of follow-up.
The team observed that a therapeutic drug monitoring strategy also led to major cost savings in the 2 modeling approaches in rheumatoid arthritis patients.
Professor Peyrin-Biroulet's team concludes, "Available evidence indicates that a therapeutic drug monitoring strategy leads to major cost savings related to anti-TNF therapy in both IBD and rheumatoid arthritis patients, with no negative impact on efficacy."