Cost-effectiveness of Crohn's disease post-operative care

Abstract

Aim: To define the cost-effectiveness of strategies, including endoscopy and immunosuppression, to prevent endoscopic recurrence of Crohn's disease following intestinal resection.

Methods: 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.

Results: 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.

Conclusion: 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.

Trial registration: ClinicalTrials.gov NCT00989560.

Keywords: Biologics; Crohn’s disease; Health care cost; Health economics; Post-operative.

Figures

Figure 1

Consort diagram: The POCER Study.

Figure 2

Distribution of costs in post-operative Crohn’s disease in this cohort.

Figure 3

Active vs standard care arms. Total cost of care (A) and medication cost (B) in post-operative Crohn’s disease in the standard versus active care arms. Total cost of care over twelve months for patients with endoscopic remission versus recurrence (C). Boxes indicate the median and 25th and 75th percentiles, whiskers indicate calculated maximum and minimum with circles indicating outliers.