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Surgery cost-effective alternative to Remicade for ileocecal Crohn’s maintenance
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Laparoscopic ileocecal resection is a cost-effective alternative to Remicade therapy for the treatment of ileocecal Crohn’s disease, according to results of a randomized, controlled trial.
Willem A. Bemelman, MD, PhD, of the department of surgery at Amsterdam UMC in the Netherlands, and colleagues wrote that despite recent medical advances, patients with CD still need lifelong medical therapy.
“Patients failing conventional therapy are traditionally upscaled to antitumor necrosis factor therapy, such as infliximab [Remicade, Janssen],” they wrote. “However, the LIR!C Trial showed that laparoscopic ileocecal resection proved to be a valid alternative to infliximab with respect to improving quality of life. Since the use of infliximab is associated with a considerable economic burden on society, it was hypothesized that laparoscopic ileocecal resection would result in considerably lower health care resource utilization and costs, and thus societal costs, while achieving a higher quality of life.”
Researchers conducted a randomized, controlled trial at 29 centers in the Netherlands and the United Kingdom, comprising 143 patients with CD of the terminal ileum. All patients failed more than 3 months of conventional immunomodulators or steroids without signs of critical strictures. They randomly assigned patients to receive infliximab (n = 70) or ileocecal resection (n = 73) and measured costs based from a societal perspective.
Investigators found that the mean CD total direct health care costs per patients at 1 year were lower in the resection group compared with the infliximab group (mean difference -8,932 euros; 95% CI, -12,087 to -5,097 euros). The total societal costs were also lower in the resection group, but the difference was not significant.
Additionally, patients in the resection group had a higher mean number of quality of life years (QALY) after 12 months compared with the infliximab group (0.81 vs. 0.74; mean difference = 0.07; 95% CI, 0.01–0.12). Patients in the surgery group had higher IBD Questionnaire (IBDQ) scores, but the findings were not statistically significant.
“Laparoscopic ileocecal resection is associated with significantly more QALYs and higher IBDQ scores than infliximab at substantially lower costs,” Bemelman and colleagues wrote. “Therefore, laparoscopic ileocecal resection is considered to be more cost-effective as compared with infliximab treatment in this group of patients.” – by Alex Young
Disclosures: Bemelman reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.
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de Groof EJ, et al. Gut. 2019;doi:10.1136/gutjnl-2018-317539
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