TY - JOUR
T1 - Cost-effectiveness of laparoscopic ileocaecal resection versus infliximab treatment of terminal ileitis in Crohn's disease
T2 - the LIR!C Trial
AU - LIR!C study group
AU - de Groof, E Joline
AU - Stevens, Toer W
AU - Eshuis, Emma J
AU - Gardenbroek, Tjibbe J
AU - Bosmans, Judith E
AU - van Dongen, J M
AU - Mol, Bregje
AU - Buskens, Christianne J
AU - Stokkers, Pieter C F
AU - Hart, Ailsa
AU - D'Haens, Geert R
AU - Bemelman, Willem A
AU - Ponsioen, Cyriel Y
AU - Warusavitarne, Janindra
AU - van Bodegraven, Ad A.
AU - Brink, Menno A.
AU - J Consten, Esther C.
AU - van Wagensveld, Bart A.
AU - M Rijk, Marno C.
AU - P H Crolla, Rogier M.
AU - Noomen, Casper G.
AU - J Houdijk, Alexander P.
AU - Mallant, Rosalie C.
AU - Boom, Maarten
AU - Marsman, Willem A.
AU - Stockmann, Hein B.
AU - Bruin, Karlien
AU - Maring, John
AU - Ditzhuijsen, Theo van
AU - Prins, Hubert
AU - den Brande, Jan van
AU - Kingma, Paul
AU - Geloven, Anna van
AU - de Boer, Nanne
AU - der Peet, Donald van
AU - Jansen, Jeroen
AU - Gerhards, Michael
AU - van der Woude, Janneke
AU - Schouten, Ruud
AU - Oldenburg, Bas
AU - van Hillegersberg, Richard
AU - West, Rachel
AU - Mannaerts, Guido
AU - Spanier, Marcel
AU - Spillenaar Bilgen, Ernst Jan
AU - Lieverse, Rob
AU - der Zaag, Edwin van
AU - Depla, Annekatrien
AU - Uiterwaal, Tessa
AU - Cense, Huib
AU - de Laar, Arnold van
AU - Cahen, Djuna
N1 - © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2019/10
Y1 - 2019/10
N2 - OBJECTIVE: Evaluate the cost-effectiveness of laparoscopic ileocaecal resection compared with infliximab in patients with ileocaecal Crohn's disease failing conventional therapy.DESIGN: A multicentre randomised controlled trial was performed in 29 centres in The Netherlands and the UK. Adult patients with Crohn's disease of the terminal ileum who failed >3 months of conventional immunomodulators or steroids without signs of critical strictures were randomised to laparoscopic ileocaecal resection or infliximab. Outcome measures included quality-adjusted life-years (QALYs) based on the EuroQol (EQ) 5D-3L Questionnaire and the Inflammatory Bowel Disease Questionnaire (IBDQ). Costs were measured from a societal perspective. Analyses were performed according to the intention-to-treat principle. Missing cost and effect data were imputed using multiple imputation. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated to show uncertainty.RESULTS: In total, 143 patients were randomised. Mean Crohn's disease total direct healthcare costs per patient at 1 year were lower in the resection group compared with the infliximab group (mean difference €-8931; 95% CI €-12 087 to €-5097). Total societal costs in the resection group were lower than in the infliximab group, however not statistically significant (mean difference €-5729, 95% CI €-10 606 to €172). The probability of resection being cost-effective compared with infliximab was 0.96 at a willingness to pay (WTP) of €0 per QALY gained and per point improvement in IBDQ Score. This probability increased to 0.98 at a WTP of €20 000/QALY gained and 0.99 at a WTP of €500/point of improvement in IBDQ Score.CONCLUSION: Laparoscopic ileocaecal resection is a cost-effective treatment option compared with infliximab.CLINICAL TRIAL REGISTRATION NUMBER: Dutch Trial Registry NTR1150; EudraCT number 2007-005042-20 (closed on 14 October 2015).
AB - OBJECTIVE: Evaluate the cost-effectiveness of laparoscopic ileocaecal resection compared with infliximab in patients with ileocaecal Crohn's disease failing conventional therapy.DESIGN: A multicentre randomised controlled trial was performed in 29 centres in The Netherlands and the UK. Adult patients with Crohn's disease of the terminal ileum who failed >3 months of conventional immunomodulators or steroids without signs of critical strictures were randomised to laparoscopic ileocaecal resection or infliximab. Outcome measures included quality-adjusted life-years (QALYs) based on the EuroQol (EQ) 5D-3L Questionnaire and the Inflammatory Bowel Disease Questionnaire (IBDQ). Costs were measured from a societal perspective. Analyses were performed according to the intention-to-treat principle. Missing cost and effect data were imputed using multiple imputation. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated to show uncertainty.RESULTS: In total, 143 patients were randomised. Mean Crohn's disease total direct healthcare costs per patient at 1 year were lower in the resection group compared with the infliximab group (mean difference €-8931; 95% CI €-12 087 to €-5097). Total societal costs in the resection group were lower than in the infliximab group, however not statistically significant (mean difference €-5729, 95% CI €-10 606 to €172). The probability of resection being cost-effective compared with infliximab was 0.96 at a willingness to pay (WTP) of €0 per QALY gained and per point improvement in IBDQ Score. This probability increased to 0.98 at a WTP of €20 000/QALY gained and 0.99 at a WTP of €500/point of improvement in IBDQ Score.CONCLUSION: Laparoscopic ileocaecal resection is a cost-effective treatment option compared with infliximab.CLINICAL TRIAL REGISTRATION NUMBER: Dutch Trial Registry NTR1150; EudraCT number 2007-005042-20 (closed on 14 October 2015).
KW - Adult
KW - Cecum/surgery
KW - Colectomy/economics
KW - Cost-Benefit Analysis
KW - Crohn Disease/economics
KW - Female
KW - Follow-Up Studies
KW - Gastrointestinal Agents/economics
KW - Health Care Costs
KW - Humans
KW - Ileitis/diagnosis
KW - Ileum/surgery
KW - Infliximab/economics
KW - Laparoscopy/economics
KW - Male
KW - Retrospective Studies
KW - Treatment Outcome
KW - Young Adult
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UR - https://www.ncbi.nlm.nih.gov/pubmed/31233395
U2 - https://doi.org/10.1136/gutjnl-2018-317539
DO - https://doi.org/10.1136/gutjnl-2018-317539
M3 - Article
C2 - 31233395
SN - 0017-5749
VL - 68
SP - 1774
EP - 1780
JO - Gut
JF - Gut
IS - 10
ER -
