Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Department of Healthcare Economics and Health Policy, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
J Cardiol. 2022 Aug;80(2):172-178. doi: 10.1016/j.jjcc.2022.03.005. Epub 2022 Mar 25.
Infliximab (IFX) treatment is approved in Japan for health insurance coverage in patients with Kawasaki disease (KD). This study aimed to compare the cost-effectiveness of IFX and other therapeutic strategies for KD refractory to initial treatment, including intravenous immunoglobulin (IVIG), steroids, immunosuppressants, and plasma exchange therapy.
This multicenter, retrospective cohort study utilized data from the public medical insurance system of Japan. The target population included those who received treatment for KD between April 2012 and March 2019. Eligibility criteria were as follows: 1) initial onset of KD, 2) age < 15 years at onset, and 3) administration of 3rd line treatment if the 1st line treatment was IVIG alone or 2nd line treatment if the 1st line treatment was a combination of IVIG and steroids, in accordance with Japanese guidelines (2012). Those with KD-related cardiovascular complications before admission and those with congenital cardiac disease were excluded. The primary outcome was cost-effectiveness, which was calculated based on the number of admission events per annum divided by medical expenses per annum (times/10,000 US dollars). The Wilcoxon test was applied to analyze the difference in cost-effectiveness between patients who had received IFX and those who had not.
Among 1267 patients with KD, 25 received IFX treatment, while 206 received another treatment after the disease was designated refractory to initial treatment. The frequency of steroid use during initial IVIG treatment (a predictor of severity) was higher in the non-IFX group than in the IFX group (70.4% vs. 32.0%, p < 0.001) but became comparable after propensity-score matching. Our analysis indicated that IFX was more cost-effective than other treatments [1.04 (0.86, 1.34) vs. 1.38 (1.03, 1.79) (times/10,000 US dollars), p = 0.006].
IFX treatment may be more cost-effective than non-IFX treatment for patients with KD that is refractory to initial treatment.
英夫利昔单抗（IFX）治疗已在日本获得批准，可用于保险覆盖范围内的川崎病（KD）患者。本研究旨在比较 IFX 与其他治疗策略在治疗初始治疗无效的 KD 患者中的成本效益，这些策略包括静脉注射免疫球蛋白（IVIG）、皮质类固醇、免疫抑制剂和血浆置换疗法。
这是一项多中心回顾性队列研究，利用了日本公共医疗保险系统的数据。目标人群包括 2012 年 4 月至 2019 年 3 月期间接受 KD 治疗的患者。纳入标准如下：1）KD 初发，2）发病时年龄＜15 岁，3）根据日本指南（2012 年），一线治疗仅为 IVIG 或一线治疗为 IVIG 和皮质类固醇的二线治疗后，给予三线治疗。排除入院前有 KD 相关心血管并发症和先天性心脏病的患者。主要结局为成本效益，根据每年入院事件数除以每年医疗费用（倍/10000 美元）计算。采用 Wilcoxon 检验分析接受 IFX 治疗和未接受 IFX 治疗的患者的成本效益差异。
在 1267 例 KD 患者中，25 例接受 IFX 治疗，206 例在疾病被指定为初始治疗无效后接受了其他治疗。在初始 IVIG 治疗期间使用皮质类固醇（严重程度的预测因素）的频率在非 IFX 组高于 IFX 组（70.4% vs. 32.0%，p＜0.001），但在倾向评分匹配后变得相似。我们的分析表明，IFX 比其他治疗更具成本效益[1.04（0.86，1.34）vs. 1.38（1.03，1.79）（倍/10000 美元），p=0.006]。
对于初始治疗无效的 KD 患者，IFX 治疗可能比非 IFX 治疗更具成本效益。
