DOP67 First-line infliximab is cost-effective compared to conventional treatment in paediatric Crohn’s Disease – Results from the TISKids study
Vuijk, S.(1);Jongsma, M.(1);Hoeven, B.(1);Cozijnsen, M.(1);van Pieterson, M.(1);de Meij, T.(2);Norbruis, O.(3);Groeneweg, M.(4);Wolters, V.(5);van Wering, H.(6);Hummel, T.(7);Stapelbroek, J.(8);van der Feen, C.(9);van Rheenen, P.(10);van Wijk, M.(2);Teklenburg, S.(3);Poleij, M.(11);Escher, J.(1);de Ridder, L.(1);
(1)Erasmus Medical Center/Sophia Children’s Hospital, Paediatric Gastroenterology, Rotterdam, The Netherlands;(2)Emma Children's Hospital- Amsterdam UMC- VU University, Paediatric Gastroenterology, Amsterdam, The Netherlands;(3)Isala Hospital, Paediatric Gastroenterology, Zwolle, The Netherlands;(4)Maasstad Hospital, Paediatric Gastroenterology, Rotterdam, The Netherlands;(5)Utrecht Medical Center/ Wilhelmina Children’s Hospital, Paediatric Gastroenterology, Utrecht, The Netherlands;(6)Amphia Hospital, Paediatric Gastroenterology, Breda, The Netherlands;(7)Medical Spectrum Twente, Paediatric Gastroenterology, Enschede, The Netherlands;(8)Catharina Hospital, Paediatric Gastroenterology, Eindhoven, The Netherlands;(9)Jeroen Bosch Hospital, Paediatric Gastroenterology, ‘s Hertogenbosch, The Netherlands;(10)University of Groningen- University Medical Center Groningen, Paediatric Gastroenterology, Groningen, The Netherlands;(11)Erasmus University Rotterdam, Health Policy and Management, Rotterdam, The Netherlands;
Background
First-line infliximab (FL-IFX) induction treatment combined with azathioprine (AZA) is more effective to achieve clinical remission without treatment escalation at week 52 compared to conventional induction treatment (CONV) (Exclusive Enteral Nutrition or prednisone) combined with AZA in children with moderate-to-severe Crohn’s disease (CD). FL-IFX may lead to higher treatment costs compared to conventional treatment. However, data on cost-effectiveness of FL-IFX in children with CD is still limited. Therefore, our aim is to investigate the cost-effectiveness of FL-IFX in comparison with CONV. We hypothesized that cost effectiveness of FL-IFX is comparable to CONV in children with newly diagnosed moderate-to-severe CD in the first two years after treatment.
Methods
We included patients from the TISKids international randomized controlled trial in which children with moderate-to-severe CD were treated with either FL-IFX (Inflectra, biosimilar of IFX) or CONV.(1) Patients included outside of the Netherlands (n=6) or patients with serious comorbidity besides CD were excluded from this analysis (n=2). Data on healthcare consumption and costs were obtained per hospital for all included patients until week 104. Direct health-related costs were collected, including hospital visits, drug costs, laboratory tests, endoscopies and surgeries. The effectiveness of treatment was assessed by mean weighted paediatric CD activity index (wPCDAI) and faecal calprotectin (fcal) levels (µg/g) measured over time until week 104. This analysis was performed by a mixed model. Moreover, time to additional anti-tumor necrosis factor-α (anti-TNF) treatment up to 104 weeks after inclusion was assessed.
Results
In this analysis, 89 patients were included, 44 in the FL-IFX group and 45 in the conventional treatment group. There were no significant differences between the two groups at baseline. Interestingly, the mean costs were similar for FL-IFX (€34,783) and CONV (€34,923) after two years, p=0.97 (Figure 1). Mean fcal levels were lower for FL-IFX compared to CONV over two years (416 vs. 625, p=0.03). The mean wPCDAI scores over two years were numerically lower for FL-IFX compared to CONV (5.95 vs. 10.34, p=0.01), but this difference became smaller over time. Furthermore, the time to (re)start anti-TNF treatment was significantly longer in the FL-IFX group (median 68 weeks) compared to the conventional treatment group (median 32 weeks) (p=0.02) (Figure 2).
Conclusion
Treatment with FL-IFX is cost-effective compared to conventional treatment in the first two years after diagnosis in children with moderate-to-severe CD.
References:
1. Jongsma MME et al. Gut. 2020 Dec 31; DOI: 10.1136/gutjnl-2020-322339. / PMID: 33384335
