Department of Microbiota Medicine & Medical Center for Digestive Diseases, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Key Lab of Holistic Integrative Enterology, The Second Affiliated Hospital of Nanjing Medical University, Nanjing, China.
J Chin Med Assoc. 2024 Jan 1;87(1):109-118. doi: 10.1097/JCMA.0000000000001025. Epub 2023 Nov 21.
Both infliximab (IFX) and fecal microbiota transplantation (FMT) have shown the efficacy for inflammatory bowel disease (IBD). However, there has no head-to-head study on the cost-value of the such treatments on IBD. This study aimed to compare the medical costs using IFX and the new method of FMT (washed microbiota transplantation [WMT]) in the long-term management for IBD under the current health economic condition in China.
Patients with IBD who underwent initial WMT via upper gastrointestinal endoscopy, mid-gut tube, or colonic transendoscopic enteral tubing at a university hospital between April 2013 and August 2021 and achieved the long-term sustainment with WMT or WMT combined with mesalazine until August 2022 were recruited in the real-world. The costs and hospitalizations were analyzed among two therapies mentioned above and IFX standard therapy. The charge of WMT was stable in the long term at our center, and the charge of IFX came from virtual statistics publicized by China Healthcare Security.
Sixty eligible patients with IBD were included in the study. The long-term costs of patients using WMT monotherapy annually or per hospitalization were lower than those on WMT combined with mesalazine, respectively ( p < 0.001, respectively). The cumulative costs of IFX at the time of 0.52 and 0.85 years exceeded that of the above WMT, respectively ( p < 0.001, respectively). Besides, patients on WMT monotherapy paid 51.1 k CNY annually in the nonsustain phase but cut down the costs by 7.2 k CNY and duration of hospitalization by 5.1 days per hospitalization when reaching the goal of sustainment.
This study demonstrated that WMT could dramatically reduce the cost and duration of hospitalizations in the long-term sustainment in the current Chinese IBD cohort. Compared with IFX, WMT could be a good way for the patients with IBD achieving long-term sustainment and saving medical costs.
英夫利昔单抗（IFX）和粪便微生物群移植（FMT）已显示出对炎症性肠病（IBD）的疗效。然而，目前尚无关于 IBD 治疗成本效益的头对头研究。本研究旨在比较在中国当前卫生经济条件下，用于 IBD 长期管理的 IFX 和 FMT 的新方法（洗必泰微生物群移植[WMT]）的医疗成本。
2013 年 4 月至 2021 年 8 月期间，在一所大学医院通过上消化道内镜、中肠管或结肠经内镜肠内插管进行初始 WMT 并在 2022 年 8 月前通过 WMT 或 WMT 联合美沙拉嗪长期维持的 IBD 患者被纳入真实世界研究。分析上述两种治疗方法与 IFX 标准治疗的成本和住院情况。本中心 WMT 的费用在长期内保持稳定，IFX 的费用来自中国医疗保险公布的虚拟统计数据。
本研究纳入了 60 名符合条件的 IBD 患者。WMT 单药治疗每年或每次住院的长期费用均低于 WMT 联合美沙拉嗪（p<0.001）。在 0.52 和 0.85 年时，IFX 的累积成本超过了上述 WMT 的成本（p<0.001）。此外，在无法维持的阶段，WMT 单药治疗的患者每年需支付 51100 元人民币，但在达到维持目标时，每年可节省 7200 元人民币和 5.1 天的住院时间。
本研究表明，在当前中国 IBD 队列中，WMT 可显著降低长期维持的成本和住院时间。与 IFX 相比，WMT 可能是 IBD 患者实现长期维持和节省医疗成本的一种较好的方法。
