Cost utility of inflammation-targeted therapy for patients with ulcerative colitis

Abstract

Background & aims: Oral mesalamine drugs are frequently used to treat patients with mild-to-moderate ulcerative colitis (UC). However, these drugs are costly, and long-term adherence is poor. We compared the cost utility of inflammation-targeted, intermittent therapy with that of universal, continuous maintenance therapy with mesalamine agents for patients with mild-to-moderate UC.

Methods: We developed a Markov cohort model that simulated a population of adult patients with newly diagnosed, quiescent UC after induction of remission with mesalamine agents. We obtained model inputs from the literature. The perspective taken was that of a short-term payer (health insurance provider) during a 5-year time period. We modeled 3 treatment strategies: symptom-targeted treatment (treatment for symptomatic disease flares only, SYMPT), continuous mesalamine maintenance for all patients (CONT, the current standard of care), and inflammation-targeted treatment (mesalamine therapy for only patients with a stool sample positive for an inflammatory marker, INFLAM). We measured disease flares, quality-adjusted life years (QALYs), costs (2009 U.S. dollars), and incremental cost-effectiveness ratios.

Results: INFLAM was the least costly strategy (cumulative per-patient cost of $22,798), compared with $24,378 for the SYMPT and $25,621 for the CONT strategies. Despite the lower cost, INFLAM was comparable to SYMPT and CONT in effectiveness (4.4986 vs 4.5014 QALYs, respectively), making INFLAM the optimal strategy. Several variables were found to be important in sensitivity analysis; the CONT strategy was optimal only if the cost of mesalamine drugs was markedly reduced.

Conclusions: Inflammation-targeted treatment of patients with UC is effective and costs less than continuous treatment of all patients with mesalamine, the current standard of care. Prospective trials of inflammation-targeted treatment are warranted.