Cost-effectiveness analysis of adjunct VSL#3 therapy versus standard medical therapy in pediatric ulcerative colitis
| Autor: | Dorsey Bass, K.T. Park, Felipe Perez, Anita Honkanen, Alan M. Garber, Raymond Tsai |
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| Rok vydání: | 2011 |
| Předmět: |
medicine.medical_specialty
Pediatrics medicine.medical_treatment Cost-Benefit Analysis Inflammatory bowel disease Quality of life Azathioprine Medicine Combined Modality Therapy Humans Child Mesalamine health care economics and organizations Colectomy Randomized Controlled Trials as Topic business.industry Gastroenterology Antibodies Monoclonal Standard of Care Pouchitis Cost-effectiveness analysis Health Care Costs medicine.disease Ulcerative colitis Infliximab Surgery Quality-adjusted life year Models Economic Treatment Outcome Pediatrics Perinatology and Child Health Colitis Ulcerative Quality-Adjusted Life Years business |
| Zdroj: | Journal of pediatric gastroenterology and nutrition. 53(5) |
| ISSN: | 1536-4801 |
| Popis: | BACKGROUND: Inflammatory bowel diseases (IBDs) are costly chronic gastrointestinal diseases, with pediatric IBD representing increased costs per patient compared to adult disease. Health care expenditures for ulcerative colitis (UC) are >$2 billion annually. It is not clear whether the addition of VSL#3 to standard medical therapy in UC induction and maintenance of remission is a cost-effective strategy. PATIENTS AND METHODS: We performed a systematic review of the literature and created a Markov model simulating a cohort of 10-year-old patients with severe UC, studying them until 100 years of age or death. We compared 2 strategies: standard medical therapy versus medical therapy + VSL#3. For both strategies, we assumed that patients progressed through escalating therapies--mesalamine, azathioprine, and infliximab--before receiving a colectomy + ileal pouch anal anastamosis (IPAA) if the 3 medical therapy options were exhausted. The primary outcome measure was the incremental cost-effectiveness ratio (ICER), defined as the difference of costs between strategies for each quality-adjusted life-year (QALY) gained. One-way sensitivity analyses were performed on variables to determine the key variables affecting cost-effectiveness. RESULTS: Standard medical care accrued a lifetime cost of $203,317 per patient, compared to $212,582 per patient for medical therapy + VSL#3. Lifetime QALYs gained was comparable for standard medical therapy and medical therapy + VSL#3 at 24.93 versus 25.05, respectively. Using the definition of ICER |
| Databáze: | OpenAIRE |
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