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 22 February 2018

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Alternative disease management in Crohn's disease

Alternative strategies reduce the total cost of care for steroid treated chronically active Crohn's patients, reports October's American Journal of Gastroenterology.

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Azathioprine is effective for the maintenance of a steroid free remission in Crohn's disease.

Thiopurine methyltransferase is important for the metabolism of azathioprine and influences the production of active azathioprine metabolites.

Dr Marla Dubinsky and colleagues assessed azathioprine dose selection based on pharmacogenetic testing of thiopurine methyltransferase and metabolite monitoring.

The research team evaluated whether this treatment may offer a safety and efficacy advantage over traditional dosing strategies.

The team performed a decision analysis to estimate the potential costs and effectiveness of thiopurine methyltransferase screening.

A decision analysis was also performed to estimate the potential costs and effectiveness of metabolite monitoring.

Costly strategy with thiopurine methyltransferase was $3861 vs $7142 with community care
American Journal of Gastroenterology

The team assessed whether the decision analysis can be used as disease management strategies for Crohn's disease.

Strategies applying thiopurine methyltransferase and/or metabolite monitoring to influence treatment decisions were compared to community care.

The researchers evaluated the impact on toxicity minimization and improved time to initial and sustained response.

A 1-year model was developed from the third-party payer perspective for mild to moderately chronically active, steroid-treated Crohn's disease patients.

Effectiveness and toxicity were defined by time to response and Crohn's activity index.

The team also defined effectiveness and toxicity as time to sustained response and reduction in leukopenic events, respectively.

The researchers conducted 1- and 2-way sensitivity analyses.

The team determined the effect of varying individual estimates from those used in the base-case analysis.

Metabolite monitoring, and thiopurine methyltransferase as compared to community care achieved an earlier time to initial response.

Thiopurine methyltransferase with metabolite monitoring strategies as compared to community care achieved an earlier time to initial response.

In addition the team found that sustained response as compared to community care achieved an earlier time to initial response.

The researchers noted that least costly strategy at 1 yr was thiopurine methyltransferase at $3861.

The research team found that the most costly strategy was community care at $7142.

Each alternative strategy was shown to dominate community care by less costs and faster time to response or sustained response.

The team reported that the cost-effectiveness rankings were robust to sensitivity analyses on key variables.

The addition of alternative strategies to community care may improve azathioprine outcomes.

The researchers also found that alternative strategies reduce the total cost of care for steroid treated chronically active Crohn's patients.

Dr Dubinsky's team concluded, “Thiopurine methyltransferase was more beneficial for initial response to treatment and metabolite monitoring being more beneficial for sustained response to treatment.”

Am J Gastroenterol 2005: 100(10): 2239
07 October 2005

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