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Economic evaluations of treatments for inflammatory bowel diseases

      Objectives

      In recent years, there has been a rapid growth in the development of novel biological treatments. Numerous economic evaluations have been performed to evaluate these treatments in inflammatory bowel diseases (IBD). The objective of this project was to explore the existing evidences regarding the cost-effectiveness of treatments in IBD.

      Methods

      A systematic review of the literature was conducted to identify economic evaluations of IBD therapy reporting incremental cost-effectiveness or cost-utility ratios (ICERs or ICURs). The literature search was performed using electronic databases. Searches were limited to full economic evaluations published in English or French between 2003 and 2013. Cross-reference of retrieved articles was also performed to identify additional publications.

      Results

      A total of 15,242 potentially relevant studies were identified. After screening titles and abstracts, 43 full-text articles were assessed according to the eligibility criteria and 35 studies were included. Among those, 3 studies assessed the economic impact of IBD treatments with a companion diagnostic test. A high proportion of economic evaluations was performed from a third party payer perspective (91%) and had time horizons of 1 year or less (46%). European, American and Canadian economic evaluations accounted for 66%, 17% and 11% of the studies respectively. Treatment options under evaluation included azathioprine, infliximab, adalimumab, immunosuppressant and mesalamine. Most included studies were cost-utility analyses (94%), with ICURs ranging from dominant to CAD$11,934,934/QALY. More specifically, treatment under investigation was dominant in 26% of the analyses and was cost-effective according to a CAD$50,000/QALY and a CAD$100,000/QALY threshold in 31% and 65% of the analyses respectively.

      Conclusions

      Several economic evaluations were conducted in the past years, with different parameters and results. As more treatment options become available, this review provides a comprehensive overview of evaluations previously performed and could be helpful in the realization of future economic evaluations.