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Cost-effectiveness analysis of increased adalimumab dose intervals in Crohn's disease patients in stable remission: the randomized controlled LADI trial
Background and Aims
We aimed to assess cost-effectiveness of increasing adalimumab dose intervals compared to the conventional dosing interval in patients with Crohn’s disease [CD] in stable clinical and biochemical remission.
Design
We conducted a pragmatic, open-label, randomized controlled non-inferiority trial, comparing increased adalimumab intervals with the 2-weekly interval in adult CD patients in clinical remission. Quality of life was measured with the EQ-5D-5L. Costs were measured from a societal perspective. Results are shown as differences and incremental net monetary benefit [iNMB] at relevant willingness to accept [WTA] levels.
Results
We randomized 174 patients to the intervention [n = 113] and control [n = 61] groups. No difference was found in utility (difference: −0.017, 95% confidence interval [−0.044; 0.004]) and total costs (−€943, [−€2226; €1367]) over the 48-week study...
Show moreBackground and Aims
We aimed to assess cost-effectiveness of increasing adalimumab dose intervals compared to the conventional dosing interval in patients with Crohn’s disease [CD] in stable clinical and biochemical remission.
Design
We conducted a pragmatic, open-label, randomized controlled non-inferiority trial, comparing increased adalimumab intervals with the 2-weekly interval in adult CD patients in clinical remission. Quality of life was measured with the EQ-5D-5L. Costs were measured from a societal perspective. Results are shown as differences and incremental net monetary benefit [iNMB] at relevant willingness to accept [WTA] levels.
Results
We randomized 174 patients to the intervention [n = 113] and control [n = 61] groups. No difference was found in utility (difference: −0.017, 95% confidence interval [−0.044; 0.004]) and total costs (−€943, [−€2226; €1367]) over the 48-week study period between the two groups. Medication costs per patient were lower (−€2545, [−€2780; −€2192]) in the intervention group, but non-medication healthcare (+€474, [+€149; +€952]) and patient costs (+€365 [+€92; €1058]) were higher. Cost–utility analysis showed that the iNMB was €594 [−€2099; €2050], €69 [−€2908; €1965] and −€455 [−€4,096; €1984] at WTA levels of €20 000, €50 000 and €80 000, respectively. Increasing adalimumab dose intervals was more likely to be cost-effective at WTA levels below €53 960 per quality-adjusted life year. Above €53 960 continuing the conventional dose interval was more likely to be cost-effective.
Conclusion
When the loss of a quality-adjusted life year is valued at less than €53 960, increasing the adalimumab dose interval is a cost-effective strategy in CD patients in stable clinical and biochemical remission.
Show less- All authors
- Jansen, F.M.; Linschoten, R.C.A. van; Kievit, W.; Smits, L.J.T.; Pauwels, R.W.M.; Jong, D.J. de; Vries, A.C. de; Boekema, P.J.; West, R.L.; Bodelier, A.G.L.; Gisbertz, I.A.M.; Wolfhagen, F.H.J.; Römkens, T.E.H.; Lutgens, M.W.M.D.; Bodegraven, A.A. van; Oldenburg, B.; Pierik, M.J.; Russel, M.G.V.M.; Boer, N.K. de; Mallant-Hent, R.C.; Borg, P.C.J. ter; Jong, A.E.V.; Jansen, J.M.; Jansen, S.; Tan, A.C.I.T.L.; Hoentjen, F.; Woude, C.J. van der; LADI Study Grp; Dutch ICC
- Date
- 2023-06-13
- Journal
- Journal of Crohn's and Colitis
- Volume
- 17
- Issue
- 11
- Pages
- 1771 - 1780