TY - JOUR
T1 - Cost-effectiveness analysis of increased adalimumab dose intervals in Crohn's disease patients in stable remission
T2 - The Randomized Controlled LADI Trial
AU - Jansen, Fenna M
AU - van Linschoten, Reinier C A
AU - Kievit, Wietske
AU - Smits, Lisa J T
AU - Pauwels, Renske W M
AU - de Jong, Dirk J
AU - de Vries, Annemarie C
AU - Boekema, Paul J
AU - West, Rachel L
AU - Bodelier, Alexander G L
AU - Gisbertz, Ingrid A M
AU - Wolfhagen, Frank H J
AU - Römkens, Tessa E H
AU - Lutgens, Maurice W M D
AU - van Bodegraven, Adriaan A
AU - Oldenburg, Bas
AU - Pierik, Marieke J
AU - Russel, Maurice G V M
AU - de Boer, Nanne K
AU - Mallant-Hent, Rosalie C
AU - Ter Borg, Pieter C J
AU - van der Meulen-de Jong, Andrea E
AU - Jansen, Jeroen M
AU - Jansen, Sita V
AU - Tan, Adrianus C I T L
AU - Hoentjen, Frank
AU - van der Woude, C Janneke
AU - LADI Study Group
AU - Dutch Initiative on Crohn and Colitis (ICC)
PY - 2023/11/1
Y1 - 2023/11/1
N2 - BACKGROUND AND AIMS: 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, randomised controlled non-inferiority trial, comparing increased adalimumab intervals with the two-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 randomised 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, [-2,226; €1,367] over the 48-week study period between the two groups. Medication costs per patient were lower (-€2,545, [-€2,780; -€2,192]) in the intervention group, but non-medication healthcare (+€474, [+€149; +€952]) and patient costs (+€365 [+€92; €1,058]) were higher. Cost-utility analysis showed that the iNMB was €594 ([-€2,099; €2,050]), €69 [-€2,908; €1,965], and -€455 [-€4,096; €1,984] at WTA levels of €20,000; €50,000; and €80,000. Increasing adalimumab dose intervals was more likely to be cost-effective at WTA levels below €53,960 per QALY. 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.
AB - BACKGROUND AND AIMS: 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, randomised controlled non-inferiority trial, comparing increased adalimumab intervals with the two-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 randomised 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, [-2,226; €1,367] over the 48-week study period between the two groups. Medication costs per patient were lower (-€2,545, [-€2,780; -€2,192]) in the intervention group, but non-medication healthcare (+€474, [+€149; +€952]) and patient costs (+€365 [+€92; €1,058]) were higher. Cost-utility analysis showed that the iNMB was €594 ([-€2,099; €2,050]), €69 [-€2,908; €1,965], and -€455 [-€4,096; €1,984] at WTA levels of €20,000; €50,000; and €80,000. Increasing adalimumab dose intervals was more likely to be cost-effective at WTA levels below €53,960 per QALY. 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.
KW - Adalimumab
KW - Crohn’s disease
KW - dose de-escalation
U2 - 10.1093/ecco-jcc/jjad101
DO - 10.1093/ecco-jcc/jjad101
M3 - Article
SN - 1873-9946
VL - 17
SP - 1771
EP - 1780
JO - Journal of Crohn's & Colitis
JF - Journal of Crohn's & Colitis
IS - 11
ER -