The economic evaluation of early intervention with anti-tumor necrosis factor-α treatments in pediatric Crohn's disease

Bashir NS, Walters TD, Griffiths AM, Ito S, Ungar WJ
Record ID 32018000446
Authors' objectives: The primary objective was to assess the incremental cost-effectiveness of early intervention with anti-TNF-α treatment vs. conventional step-up strategy at improving the number of steroid-free remission weeks gained from public healthcare payer and societal perspectives.
Authors' results and conclusions: From a public healthcare payer perspective, early intervention with anti-TNF-α treatment was more costly with an incremental cost of $31,112 (95% CI: 2,939, 91,715) and more effective with 11.3 more weeks in steroid-free remission (95% CI: 10.6, 11.6) compared to standard care, resulting in an incremental cost per steroid-free remission week gained of $2,756. From a societal perspective, the incremental cost per steroid-free remission week gained for early anti-TNF-α treatment was $2,968. While unknown, if a willingness-to-pay threshold was assumed to be $2,500 per week in steroid-free remission, early intervention with anti-TNF-α would not be cost-effective. However, there is considerable uncertainty in the incremental cost-effectiveness ratio and many patients escalate to anti-TNF-α eventually. Therefore, restrictive policies on anti-TNF-α treatment access for pediatric Crohn’s patients may want to be re-visited by decision makers.
Authors' methods: A two-dimensional probabilistic microsimulation Markov model with seven health states was constructed for children with moderate to severe Crohn’s disease. Newly-diagnosed children with Crohn’s disease aged 4-17 years who received anti-TNF-α treatment and other concomitant treatments, such as steroids and immunomodulators, within the first three months of diagnosis were compared to children with newly-diagnosed Crohn’s disease who received standard care of steroids and/or immunomodulators with the possibility of anti-TNF-α treatment only after three months of diagnosis. The outcome measure was weeks in steroid-free remission. The time horizon was three years. To reduce selection bias, propensity score analysis was used.
Project Status: Completed
Year Published: 2019
English language abstract: An English language summary is available
Publication Type: Not Assigned
Country: Canada
MeSH Terms
  • Child
  • Child, Preschool
  • Adolescent
  • Tumor Necrosis Factor-alpha
  • Cost-Benefit Analysis
  • Crohn Disease
  • Infliximab
  • Models, Economic
  • Antibodies, Monoclonal
  • Antirheumatic Agents
  • Anti-Inflammatory Agents
  • Treatment Outcome
  • anti-TNF-α
  • cost-effectiveness analysis
  • economic evaluation
  • infliximab
  • pediatric Crohn’s disease
Organisation Name: Technology Assessment at SickKids
Contact Address: Program of Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario M5G 1X8 tel: (416) 813-8519 fax: (416) 813-5979
Contact Name:
Contact Email:
Copyright: Technology Assessment Unit of the Hospital for Sick Children (TASK)
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