Department of Gastroenterology, University of Liverpool, Liverpool, UK.
Pharmacoeconomics. 2011 May;29(5):387-401. doi: 10.2165/11584820-000000000-00000.
Traditionally, half of the direct costs associated with chronic inflammatory bowel diseases (IBD) [Crohn's disease (CD) and ulcerative colitis (UC)] have related to hospital inpatient treatment for a sub-group of more severely affected, often therapy-resistant individuals. The advent of effective but relatively expensive biological agents has increased the contribution of drugs to overall medical care costs. This has focussed interest on the relative cost effectiveness of rival therapies for IBD and, in particular, on the affordability of long-term biological therapy. The purpose of this article is to review the available literature on this topic and to identify areas for future research. Head-to-head trials of competing treatment options are uncommon and clinical trials have seldom addressed cost effectiveness. In UC, models have explored the cost utility of 'high-' versus 'standard-' dose 5-aminosalicylic acid (5-ASA) therapy and the theoretical impact of improved adherence with once-daily formulations. In CD, cost-utility models for anti-tumour necrosis factor (TNF) drugs versus standard care have suggested consistently that incremental benefits are achieved at increased overall cost. However, studies of varying design have produced a wide spectrum of incremental cost-effectiveness ratio estimates, which highlights the challenges and limitations of existing modelling techniques.
传统上，与慢性炎症性肠病（IBD）[克罗恩病（CD）和溃疡性结肠炎（UC）]相关的直接成本的一半与住院治疗的一小部分更严重、经常对抗治疗无效的个体有关。有效的但相对昂贵的生物制剂的出现增加了药物对整体医疗费用的贡献。这使得人们对 IBD 的竞争治疗方法的相对成本效益产生了兴趣，特别是对长期生物治疗的可负担性产生了兴趣。本文的目的是回顾这一主题的现有文献，并确定未来研究的领域。竞争治疗方案的头对头试验并不常见，临床试验很少涉及成本效益。在 UC 中，模型已经探讨了“高剂量”与“标准剂量”5-氨基水杨酸（5-ASA）治疗的成本效用，以及改善每日一次制剂的依从性的理论影响。在 CD 中，抗肿瘤坏死因子（TNF）药物与标准治疗相比的成本效用模型一致表明，在增加总体成本的同时获得了增量效益。然而，不同设计的研究产生了广泛的增量成本效益比估计范围，这突出了现有建模技术的挑战和局限性。
