Journal Article

Proactive Vs Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Disease: A Cost-Effectiveness Analysis in a Simulated Cohort

Negoescu, Diana M, Swanhorst, Brooke, Baumgartner, Bonnie, Vaughn, Byron P, Osterman, Mark T, Campbell, James P, Enns, Eva A, Papamichael, Konstantinos, Cheifetz, Adam S

2020

Overview

Proactive therapeutic drug monitoring of infliximab is a marginally cost-effective strategy for Crohn’s disease, whereas reactive therapeutic drug monitoring is cost-effective. As the cost of infliximab decreases, a proactive strategy of dosing infliximab becomes more cost-effective. AbstractBackgroundTherapeutic drug monitoring (TDM) is increasingly performed for Infliximab (IFX) in patients with Crohn’s disease (CD). Reactive TDM is a cost-effective strategy to empiric IFX dose escalation. The cost-effectiveness of proactive TDM is unknown. The aim of this study is to assess the cost-effectiveness of proactive vs reactive TDM in a simulated population of CD patients on IFX.MethodsWe developed a stochastic simulation model of CD patients on IFX and evaluated the expected health costs and outcomes of a proactive TDM strategy compared with a reactive strategy. The proactive strategy measured IFX concentration and antibody status every 6 months, or at the time of a flare, and dosed IFX to a therapeutic window. The reactive strategy only did so at the time of a flare.ResultsThe proactive strategy led to fewer flares than the reactive strategy. More patients stayed on IFX in the proactive vs reactive strategy (63.4% vs 58.8% at year 5). From a health sector perspective, a proactive strategy was marginally cost-effective compared with a reactive strategy (incremental cost-effectiveness ratio of $146,494 per quality-adjusted life year), assuming a 40% of the wholesale price of IFX. The results were most sensitive to risk of flaring with a low IFX concentration and the cost of IFX.ConclusionsAssuming 40% of the average wholesale acquisition cost of biologic therapies, proactive TDM for IFX is marginally cost-effective compared with a reactive TDM strategy. As the cost of infliximab decreases, a proactive monitoring strategy is more cost-effective.

• Publisher: Oxford University Press
• Subject: Adalimumab / Cohort Studies / Comparative analysis / Computer Simulation / Cost analysis / Cost benefit analysis / Crohn Disease - blood / Crohn Disease - drug therapy / Crohn Disease - economics / Crohn's disease / Drug Monitoring - economics / Drug Monitoring - methods / Economic aspects / Gastrointestinal Agents - blood / Gastrointestinal Agents - economics / Gastrointestinal diseases / Health aspects / Humans / Infliximab / Infliximab - blood / Infliximab - economics / Medical care, Cost of / Monoclonal antibodies / Original Clinical / Quality-Adjusted Life Years / Therapeutic drug monitoring / Therapeutic Index, Drug