Wright Emily K, Kamm Michael A, Dr Cruz Peter, Hamilton Amy L, Ritchie Kathryn J, Bell Sally J, Brown Steven J, Connell William R, Desmond Paul V, Liew Danny
Emily K Wright, Michael A Kamm, Peter Dr Cruz, Amy L Hamilton, Kathryn J Ritchie, Sally J Bell, Steven J Brown, William R Connell, Paul V Desmond, Department of Gastroenterology, St Vincent's Hospital, University of Melbourne, Fitzroy VIC 3065, Melbourne, Australia.
World J Gastroenterol. 2016 Apr 14;22(14):3860-8. doi: 10.3748/wjg.v22.i14.3860.
To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn's disease following intestinal resection.
In the "POCER" study patients undergoing intestinal resection were treated with post-operative drug therapy. Two thirds were randomized to active care (6 mo colonoscopy and drug intensification for endoscopic recurrence) and one third to drug therapy without early endoscopy. Colonoscopy at 18 mo and faecal calprotectin (FC) measurement were used to assess disease recurrence. Administrative data, chart review and patient questionnaires were collected prospectively over 18 mo.
Sixty patients (active care n = 43, standard care n = 17) were included from one health service. Median total health care cost was $6440 per patient. Active care cost $4824 more than standard care over 18 mo. Medication accounted for 78% of total cost, of which 90% was for adalimumab. Median health care cost was higher for those with endoscopic recurrence compared to those in remission [$26347 (IQR 25045-27485) vs $2729 (IQR 1182-5215), P < 0.001]. FC to select patients for colonoscopy could reduce cost by $1010 per patient over 18 mo. Active care was associated with 18% decreased endoscopic recurrence, costing $861 for each recurrence prevented.
Post-operative management strategies are associated with high cost, primarily medication related. Calprotectin use reduces costs. The long term cost-benefit of these strategies remains to be evaluated.
确定包括内镜检查和免疫抑制在内的预防克罗恩病肠道切除术后内镜复发策略的成本效益。
在“POCER”研究中，接受肠道切除的患者接受术后药物治疗。三分之二的患者被随机分配至积极治疗组（术后6个月进行结肠镜检查，内镜复发时加强药物治疗），三分之一的患者接受无早期内镜检查的药物治疗。采用18个月时的结肠镜检查和粪便钙卫蛋白（FC）检测评估疾病复发情况。前瞻性收集18个月内的管理数据、病历审查结果和患者问卷。
从一家医疗服务机构纳入了60例患者（积极治疗组n = 43，标准治疗组n = 17）。每位患者的医疗总费用中位数为6440美元。在18个月内，积极治疗组比标准治疗组多花费4824美元。药物费用占总费用的78%，其中90%用于阿达木单抗。与病情缓解的患者相比，内镜复发患者的医疗费用中位数更高[26347美元（四分位间距25045 - 27485美元）对2729美元（四分位间距1182 - 5215美元），P < 0.001]。使用FC来选择进行结肠镜检查的患者可使每位患者在18个月内费用降低1010美元。积极治疗与内镜复发率降低18%相关，每预防一次复发的成本为861美元。
术后管理策略成本高昂，主要与药物相关。使用钙卫蛋白可降低成本。这些策略的长期成本效益仍有待评估。
