Gastrointestinal Unit, Massachusetts General Hospital Crohn's and Colitis Center, 165 Cambridge Street, 9th Floor, Boston, MA 02114, USA.
Dig Dis Sci. 2012 Feb;57(2):472-80. doi: 10.1007/s10620-011-1896-3. Epub 2011 Sep 11.
A significant proportion of patients with Crohn's disease (CD) lose response to antibodies directed against tumor necrosis factor α (TNF). Prior TNF-antagonist failure is associated with lower rates of response to subsequent TNF-antagonist therapy. In patients failing two anti-TNF agents, a choice exists between using a third-anti-TNF therapy or natalizumab (NAT), an α-4 integrin inhibitor. A cost-effectiveness analysis comparing these competing strategies has not been performed.
A decision analytic model was constructed to compare the performance of certolizumab pegol (CZP) versus NAT in patients with moderate to severe CD. Previously published estimates of efficacy of third-line anti-TNF therapy and NAT were used to inform the model. Costs were expressed in 2010 US dollars. A 1-year time frame was used for the analysis.
In the base case estimate, use of NAT was only marginally more effective [0.71 vs. 0.70 quality adjusted life-years (QALYs)] than CZP but was expensive with an incremental cost-effectiveness ratio (ICER) of $381,678 per QALY gained. For CZP 2 months response rate of at least 24%, NAT had an ICER above the willingness-to-pay (WTP) threshold. The model was sensitive to the costs of both therapies; for all CZP costs below $2,300 per dose, NAT had higher ICER than the WTP threshold. Substituting adalimumab for CZP resulted in similar ICER estimates and thresholds for NAT use.
In patients with moderate to severe CD failing two TNF-antagonists, using a third TNF-antagonist therapy appears to be a cost-effective strategy without significantly compromising treatment efficacy.
相当一部分克罗恩病（CD）患者对靶向肿瘤坏死因子 α（TNF）的抗体失去应答。先前 TNF 拮抗剂治疗失败与后续 TNF 拮抗剂治疗的应答率较低相关。在两种抗 TNF 药物治疗失败的患者中，可选择使用第三种抗 TNF 治疗药物或那他珠单抗（NAT），一种 α-4 整合素抑制剂。尚未进行比较这些竞争策略的成本效益分析。
构建了一个决策分析模型，以比较培塞利珠单抗（CZP）与 NAT 在中重度 CD 患者中的表现。先前发表的三线抗 TNF 治疗和 NAT 疗效估计用于为模型提供信息。成本以 2010 年美元表示。分析使用了 1 年的时间框架。
在基本情况估计中，NAT 的使用仅略为有效[0.71 比 0.70 质量调整生命年（QALYs）]，但费用昂贵，增量成本效益比（ICER）为每获得一个 QALY 需 381,678 美元。对于 CZP 至少 24%的 2 个月应答率，NAT 的 ICER 高于意愿支付（WTP）阈值。该模型对两种疗法的成本均敏感；对于所有 CZP 剂量成本低于 2,300 美元，NAT 的 ICER 均高于 WTP 阈值。用阿达木单抗替代 CZP 会导致类似的 NAT 使用的 ICER 估计和阈值。
在两种 TNF 拮抗剂治疗失败的中重度 CD 患者中，使用第三种 TNF 拮抗剂治疗似乎是一种具有成本效益的策略，而不会显著降低治疗效果。
