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Economic Evaluations of Treatments for Inflammatory Bowel Diseases

      Objectives

      The last decade witnessed great advances in the treatment of inflammatory bowel diseases (IBD) with the introduction of biologic therapies. Several economic evaluations have been run to evaluate these treatments. The goal of this study was to analyze the existing evidences and key parameters included in IBD cost-effectiveness studies.

      Methods

      A systematic literature review was conducted to identify economic evaluations of IBD therapy. Electronic databases (Embase and Medline) were used to identify full economic evaluations published from 2004 to 2015. Cross-references of selected articles and gray literature search were also performed to find additional publications. The health outcomes, costs, incremental cost-effectiveness (ICERs) and cost-utility ratios (ICURs) were analyzed.

      Results

      The literature review allowed identifying 3,631 potentially relevant studies. Titles and abstracts screening allowed the selection of 53 articles. After assessment of those articles, 36 were found pertinent for the review. Four other studies were added from gray literature. Different treatments were evaluated including biologics (53%), immunosuppressants (3%), biologics and immunosuppressants combination (5%) and mesalamine (28%). Infliximab was the most common biologic treatment evaluated (65%). In the cost-utility analyzes (88%), 35% had utility scores derived from IBD severity scores. The remaining studies used direct and indirect utility measurement methods, including EQ-5D (43%), standard gamble (33%), time trade off (25%) and visual analog scale (8%). Markov modeling, decision tree or a combination of both were used in 38%, 38% and 5% of the studies respectively. All studies included drug acquisition costs, 50% included treatment administration costs, 65% included hospitalization costs and 45% included surgical costs.

      Conclusions

      Several economic evaluations especially involving biologics were conducted in the past decade. This study showed that there are significant trends in key parameters, such as model development, utility measurements and costs included, which will be helpful in the feasibility of further cost-effectiveness analyses.