Individualized Therapy Is a Long-Term Cost-Effective Method Compared to Dose Intensification in Crohn’s Disease Patients Failing Infliximab

Casper Steenholdt*, Jørn Brynskov, Ole Thomsen, Lars K. Munck, Jan Fallingborg, Lisbet A. Christensen, Gitte Pedersen, Jens Kjeldsen, Bent A. Jacobsen, Anne Sophie Oxholm, Jakob Kjellberg, Klaus Bendtzen, Mark A. Ainsworth

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Results: At the scheduled week 20 follow-up study visit, response and remission rates were similar in all study subpopulations between patients treated by the algorithm or by infliximab intensification. However, the sum of healthcare costs related to Crohn’s disease was substantially lower (31 %) for patients randomized to algorithm-based interventions than infliximab intensification in the intention-to-treat population: $11,940 versus $17,236; p = 0.005. For per-protocol patients (n = 55), costs at the week 20 follow-up visit were even lower (49 %) in the algorithm group: $8,742 versus $17,236; p = 0.002. Figures were similar for patients having completed the 12-week trial as per protocol (50 % reduction in costs) (n = 45). Among patients continuing the allocated study intervention throughout the entire 20-week follow-up period (n = 29), costs were reduced by 60 % in algorithm-treated patients: $7,056 versus $17,776; p < 0.001. Cost-reduction percentages remained stable throughout one year.

Conclusion: Economic benefit of algorithm-based interventions at infliximab failure is maintained throughout 1 year.

Background: In Crohn’s disease patients failing infliximab therapy, interventions defined by an algorithm based on infliximab and anti-infliximab antibody measurements have proven more cost-effective than intensifying the infliximab regimen.

Aim: This study investigated long-term economic outcomes at the week 20 follow-up study visit and after 1 year. Clinical outcomes were assessed at week 20.

Methods: Follow-up from a 12-week, single-blind, clinical trial where patients with infliximab treatment failure were randomized to infliximab intensification (5 mg/kg every 4 weeks) (n = 36), or algorithm-defined interventions (n = 33). Accumulated costs, expressed as mean costs per patient, were based on the Danish National Patient Registry.

Original languageEnglish
JournalDigestive Diseases and Sciences
Volume60
Issue number9
Pages (from-to)2762-2770
ISSN0163-2116
DOIs
Publication statusPublished - 2015

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Crohn Disease
Treatment Failure
Registries
Clinical Trials

Keywords

  • Anti-infliximab antibody
  • Crohn’s disease
  • Inflammatory bowel disease
  • Infliximab
  • Loss of response
  • Maintenance therapy

Cite this

Steenholdt, C., Brynskov, J., Thomsen, O., Munck, L. K., Fallingborg, J., Christensen, L. A., ... Ainsworth, M. A. (2015). Individualized Therapy Is a Long-Term Cost-Effective Method Compared to Dose Intensification in Crohn’s Disease Patients Failing Infliximab. Digestive Diseases and Sciences, 60(9), 2762-2770. https://doi.org/10.1007/s10620-015-3581-4
Steenholdt, Casper ; Brynskov, Jørn ; Thomsen, Ole ; Munck, Lars K. ; Fallingborg, Jan ; Christensen, Lisbet A. ; Pedersen, Gitte ; Kjeldsen, Jens ; Jacobsen, Bent A. ; Oxholm, Anne Sophie ; Kjellberg, Jakob ; Bendtzen, Klaus ; Ainsworth, Mark A. / Individualized Therapy Is a Long-Term Cost-Effective Method Compared to Dose Intensification in Crohn’s Disease Patients Failing Infliximab. In: Digestive Diseases and Sciences. 2015 ; Vol. 60, No. 9. pp. 2762-2770.
@article{627f68546cf643c6b226213caff918ff,
title = "Individualized Therapy Is a Long-Term Cost-Effective Method Compared to Dose Intensification in Crohn’s Disease Patients Failing Infliximab",
abstract = "Results: At the scheduled week 20 follow-up study visit, response and remission rates were similar in all study subpopulations between patients treated by the algorithm or by infliximab intensification. However, the sum of healthcare costs related to Crohn’s disease was substantially lower (31 {\%}) for patients randomized to algorithm-based interventions than infliximab intensification in the intention-to-treat population: $11,940 versus $17,236; p = 0.005. For per-protocol patients (n = 55), costs at the week 20 follow-up visit were even lower (49 {\%}) in the algorithm group: $8,742 versus $17,236; p = 0.002. Figures were similar for patients having completed the 12-week trial as per protocol (50 {\%} reduction in costs) (n = 45). Among patients continuing the allocated study intervention throughout the entire 20-week follow-up period (n = 29), costs were reduced by 60 {\%} in algorithm-treated patients: $7,056 versus $17,776; p < 0.001. Cost-reduction percentages remained stable throughout one year.Conclusion: Economic benefit of algorithm-based interventions at infliximab failure is maintained throughout 1 year.Background: In Crohn’s disease patients failing infliximab therapy, interventions defined by an algorithm based on infliximab and anti-infliximab antibody measurements have proven more cost-effective than intensifying the infliximab regimen.Aim: This study investigated long-term economic outcomes at the week 20 follow-up study visit and after 1 year. Clinical outcomes were assessed at week 20.Methods: Follow-up from a 12-week, single-blind, clinical trial where patients with infliximab treatment failure were randomized to infliximab intensification (5 mg/kg every 4 weeks) (n = 36), or algorithm-defined interventions (n = 33). Accumulated costs, expressed as mean costs per patient, were based on the Danish National Patient Registry.",
keywords = "Anti-infliximab antibody, Crohn’s disease, Inflammatory bowel disease, Infliximab, Loss of response, Maintenance therapy",
author = "Casper Steenholdt and J{\o}rn Brynskov and Ole Thomsen and Munck, {Lars K.} and Jan Fallingborg and Christensen, {Lisbet A.} and Gitte Pedersen and Jens Kjeldsen and Jacobsen, {Bent A.} and Oxholm, {Anne Sophie} and Jakob Kjellberg and Klaus Bendtzen and Ainsworth, {Mark A.}",
year = "2015",
doi = "10.1007/s10620-015-3581-4",
language = "English",
volume = "60",
pages = "2762--2770",
journal = "Digestive Diseases and Sciences",
issn = "0163-2116",
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number = "9",

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Steenholdt, C, Brynskov, J, Thomsen, O, Munck, LK, Fallingborg, J, Christensen, LA, Pedersen, G, Kjeldsen, J, Jacobsen, BA, Oxholm, AS, Kjellberg, J, Bendtzen, K & Ainsworth, MA 2015, 'Individualized Therapy Is a Long-Term Cost-Effective Method Compared to Dose Intensification in Crohn’s Disease Patients Failing Infliximab', Digestive Diseases and Sciences, vol. 60, no. 9, pp. 2762-2770. https://doi.org/10.1007/s10620-015-3581-4

Individualized Therapy Is a Long-Term Cost-Effective Method Compared to Dose Intensification in Crohn’s Disease Patients Failing Infliximab. / Steenholdt, Casper; Brynskov, Jørn; Thomsen, Ole; Munck, Lars K.; Fallingborg, Jan; Christensen, Lisbet A.; Pedersen, Gitte; Kjeldsen, Jens; Jacobsen, Bent A.; Oxholm, Anne Sophie; Kjellberg, Jakob; Bendtzen, Klaus; Ainsworth, Mark A.

In: Digestive Diseases and Sciences, Vol. 60, No. 9, 2015, p. 2762-2770.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Individualized Therapy Is a Long-Term Cost-Effective Method Compared to Dose Intensification in Crohn’s Disease Patients Failing Infliximab

AU - Steenholdt, Casper

AU - Brynskov, Jørn

AU - Thomsen, Ole

AU - Munck, Lars K.

AU - Fallingborg, Jan

AU - Christensen, Lisbet A.

AU - Pedersen, Gitte

AU - Kjeldsen, Jens

AU - Jacobsen, Bent A.

AU - Oxholm, Anne Sophie

AU - Kjellberg, Jakob

AU - Bendtzen, Klaus

AU - Ainsworth, Mark A.

PY - 2015

Y1 - 2015

N2 - Results: At the scheduled week 20 follow-up study visit, response and remission rates were similar in all study subpopulations between patients treated by the algorithm or by infliximab intensification. However, the sum of healthcare costs related to Crohn’s disease was substantially lower (31 %) for patients randomized to algorithm-based interventions than infliximab intensification in the intention-to-treat population: $11,940 versus $17,236; p = 0.005. For per-protocol patients (n = 55), costs at the week 20 follow-up visit were even lower (49 %) in the algorithm group: $8,742 versus $17,236; p = 0.002. Figures were similar for patients having completed the 12-week trial as per protocol (50 % reduction in costs) (n = 45). Among patients continuing the allocated study intervention throughout the entire 20-week follow-up period (n = 29), costs were reduced by 60 % in algorithm-treated patients: $7,056 versus $17,776; p < 0.001. Cost-reduction percentages remained stable throughout one year.Conclusion: Economic benefit of algorithm-based interventions at infliximab failure is maintained throughout 1 year.Background: In Crohn’s disease patients failing infliximab therapy, interventions defined by an algorithm based on infliximab and anti-infliximab antibody measurements have proven more cost-effective than intensifying the infliximab regimen.Aim: This study investigated long-term economic outcomes at the week 20 follow-up study visit and after 1 year. Clinical outcomes were assessed at week 20.Methods: Follow-up from a 12-week, single-blind, clinical trial where patients with infliximab treatment failure were randomized to infliximab intensification (5 mg/kg every 4 weeks) (n = 36), or algorithm-defined interventions (n = 33). Accumulated costs, expressed as mean costs per patient, were based on the Danish National Patient Registry.

AB - Results: At the scheduled week 20 follow-up study visit, response and remission rates were similar in all study subpopulations between patients treated by the algorithm or by infliximab intensification. However, the sum of healthcare costs related to Crohn’s disease was substantially lower (31 %) for patients randomized to algorithm-based interventions than infliximab intensification in the intention-to-treat population: $11,940 versus $17,236; p = 0.005. For per-protocol patients (n = 55), costs at the week 20 follow-up visit were even lower (49 %) in the algorithm group: $8,742 versus $17,236; p = 0.002. Figures were similar for patients having completed the 12-week trial as per protocol (50 % reduction in costs) (n = 45). Among patients continuing the allocated study intervention throughout the entire 20-week follow-up period (n = 29), costs were reduced by 60 % in algorithm-treated patients: $7,056 versus $17,776; p < 0.001. Cost-reduction percentages remained stable throughout one year.Conclusion: Economic benefit of algorithm-based interventions at infliximab failure is maintained throughout 1 year.Background: In Crohn’s disease patients failing infliximab therapy, interventions defined by an algorithm based on infliximab and anti-infliximab antibody measurements have proven more cost-effective than intensifying the infliximab regimen.Aim: This study investigated long-term economic outcomes at the week 20 follow-up study visit and after 1 year. Clinical outcomes were assessed at week 20.Methods: Follow-up from a 12-week, single-blind, clinical trial where patients with infliximab treatment failure were randomized to infliximab intensification (5 mg/kg every 4 weeks) (n = 36), or algorithm-defined interventions (n = 33). Accumulated costs, expressed as mean costs per patient, were based on the Danish National Patient Registry.

KW - Anti-infliximab antibody

KW - Crohn’s disease

KW - Inflammatory bowel disease

KW - Infliximab

KW - Loss of response

KW - Maintenance therapy

U2 - 10.1007/s10620-015-3581-4

DO - 10.1007/s10620-015-3581-4

M3 - Journal article

C2 - 25673037

AN - SCOPUS:84939563221

VL - 60

SP - 2762

EP - 2770

JO - Digestive Diseases and Sciences

JF - Digestive Diseases and Sciences

SN - 0163-2116

IS - 9

ER -