Infliximab dose escalation vs. initiation of adalimumab for loss of response in Crohn’s disease: a cost-effectiveness analysis
Version of Record online: 11 OCT 2007
Alimentary Pharmacology & Therapeutics
Volume 26, Issue 11-12, pages 1509–1520, December 2007
How to Cite
KAPLAN, G. G., HUR, C., KORZENIK, J. and SANDS, B. E. (2007), Infliximab dose escalation vs. initiation of adalimumab for loss of response in Crohn’s disease: a cost-effectiveness analysis. Alimentary Pharmacology & Therapeutics, 26: 1509–1520. doi: 10.1111/j.1365-2036.2007.03548.x
- Issue online: 11 OCT 2007
- Version of Record online: 11 OCT 2007
- Publication dataSubmitted 6 September 2007 First decision 25 September 2007 Resubmitted 5 October 2007 Accepted 7 October 2007
Background Crohn’s disease patients who have lost response to 5 mg/kg of infliximab may regain response by increasing the dose of infliximab to 10 mg/kg. Alternatively, adalimumab can be used as a rescue therapy.
Aim To determine whether dose escalation of infliximab was a cost-effective strategy compared with adalimumab initiation after loss of response to 5 mg/kg of infliximab.
Methods A decision-analysis model simulated two cohorts of Crohn’s patients: (i) infliximab dose was escalated to 10 mg/kg and (ii) infliximab was discontinued and patients were started on adalimumab. The time horizon was 1 year. One- and two-way sensitivity analyses were performed.
Results The infliximab dose escalation strategy yielded more quality-adjusted life years (0.79) compared with the adalimumab strategy (0.76). The incremental cost-effectiveness ratio was $332 032/quality-adjusted life year. Sensitivity analysis demonstrated that the model findings were robust. The most significant variables were the cost of infliximab and that of adalimumab, such that a reduction in the cost of infliximab by 1/3 resulted in an incremental cost-effectiveness ratio below $80 000/quality-adjusted life year.
Conclusion After a Crohn’s patient has lost response to 5 mg/kg of infliximab, dose escalation will yield more quality-adjusted life-year compared with switching to adaliumamb; however, the cost was considerable.