Journal Article

Cost-effectiveness of laparoscopic ileocaecal resection versus infliximab treatment of terminal ileitis in Crohn’s disease: the LIR!C Trial

Boom, Maarten, Cahen, Djuna, Depla, Annekatrien, Marinelli, Andreas, Talstra, Nynke, Peters, Job, der Zaag, Edwin van, Oldenburg, Bas, Gardenbroek, Tjibbe J, Buskens, Christianne J, der Peet, Donald van, Vecht, Juda, Marsman, Willem A, Ponsioen, Cyriel Y, Noomen, Casper G, Hart, Ailsa, M Rijk, Marno C, Bosmans, Judith E, D’Haens, Geert R, Spillenaar Bilgen, Ernst Jan, Eshuis, Emma J, der Woude, Janneke van, Brouwer, Hans, Mannaerts, Guido, Sosef, Meindert, Kingma, Paul, Stevens, Toer W, Brink, Menno A, der Werff, Sjoerd van, Geloven, Anna van, Hillegersberg, Richard van, Hofker, Sijbrand, Eijsbouts, Quirijn, Mahmmod, Nofel, Maring, John, Mol, Bregje, Oostenbrug, Liekele, Spanier, Marcel, Jansen, Jeroen, Warusavitarne, Janindra, Dijkstra, Gerard, Morar, Pritesh, Ditzhuijsen, Theo van, Cense, Huib, de Groof, E Joline, Bemelman, Willem A, Stockmann, Hein B, Mallant, Rosalie C, Gerhards, Michael, West, Rachel, Pierik, Robert, Van Bodegraven, Ad A, den Brande, Jan van, Schouten, Ruud, Lieverse, Rob, de Laar, Arnold van, Boer, Nanne de, Hazebroek, Eric, J Consten, Esther C, Van Wagensveld, Bart A, Bruin, Karl

2019

Overview

ObjectiveEvaluate the cost-effectiveness of laparoscopic ileocaecal resection compared with infliximab in patients with ileocaecal Crohn’s disease failing conventional therapy.DesignA 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.ResultsIn 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.ConclusionLaparoscopic ileocaecal resection is a cost-effective treatment option compared with infliximab.Clinical trial registration numberDutch Trial Registry NTR1150; EudraCT number 2007-005042-20 (closed on 14 October 2015).

• Publisher: BMJ Publishing Group Ltd and British Society of Gastroenterology,BMJ Publishing Group LTD
• Subject: Biological products / Cost analysis / Crohn's disease / economic evaluation / Gastroenterology / Ileitis / Ileum / Immunomodulation / Immunotherapy / Inflammatory bowel disease / Inflammatory bowel diseases / Infliximab / Intestine / laparoscopic ileocecal resection / Laparoscopy / Monoclonal antibodies / Patients / Quality of life / Questionnaires / Sick leave / Statistical analysis / Steroid hormones / Stricture / Studies / Surgery / Surgical outcomes / Systematic review / TNF inhibitors / Travel & entertainment expenses / Tumor necrosis factor-α