Cost-effectiveness of laparoscopic ileocaecal resection versus infliximab treatment of terminal ileitis in Crohn's disease: the LIR!C Trial. Issue 10 (1st February 2019)

• Record Type: Journal Article
• Authors: de Groof, E Joline; Stevens, Toer W; Eshuis, Emma J; Gardenbroek, Tjibbe J; Bosmans, Judith E; van Dongen, JM; Mol, Bregje; Buskens, Christianne J; Stokkers, Pieter C F; Hart, Ailsa; D'Haens, Geert R; Bemelman, Willem A; Ponsioen, Cyriel Y
• Other Names: author non-byline.; Warusavitarne Janindra author non-byline.; Van Bodegraven Ad A author non-byline.; Brink Menno A author non-byline.; J Consten Esther C author non-byline.; Van Wagensveld Bart A author non-byline.; M Rijk Marno C author non-byline.; P H Crolla Rogier M author non-byline.; Noomen Casper G author non-byline.; J Houdijk Alexander P author non-byline.; Mallant Rosalie C author non-byline.; Boom Maarten author non-byline.; Marsman Willem A author non-byline.; Stockmann Hein B author non-byline.; Bruin Karlien author non-byline.; Maring John author non-byline.; Ditzhuijsen Theo van author non-byline.; Prins Hubert author non-byline.; den Brande Jan van author non-byline.; Kingma Paul author non-byline.; Geloven Anna van author non-byline.; Boer Nanne de author non-byline.; der Peet Donald van author non-byline.; Jansen Jeroen author non-byline.; Gerhards Michael author non-byline.; der Woude Janneke van author non-byline.; Schouten Ruud author non-byline.; Oldenburg Bas author non-byline.; Hillegersberg Richard van author non-byline.; West Rachel author non-byline.; Mannaerts Guido author non-byline.; Spanier Marcel author non-byline.; Spillenaar Bilgen Ernst Jan author non-byline.; Lieverse Rob author non-byline.; der Zaag Edwin van author non-byline.; Depla Annekatrien author non-byline.; de Laar Arnold van author non-byline.; Bolwerk Clemens author non-byline.; Brouwer Hans author non-byline.; Mahmmod Nofel author non-byline.; Hazebroek Eric author non-byline.; Vecht Juda author non-byline.; Pierik Robert author non-byline.; Dijkstra Gerard author non-byline.; Hofker Sijbrand author non-byline.; Uiterwaal Tessa author non-byline.; Eijsbouts Quirijn author non-byline.; Oostenbrug Liekele author non-byline.; Sosef Meindert author non-byline.; Cahen Djuna author non-byline.; der Werff Sjoerd van author non-byline.; Marinelli Andreas author non-byline.; Peters Job author non-byline.; Cense Huib author non-byline.; Talstra Nynke author non-byline.; Morar Pritesh author non-byline.;
• Is Part Of: Gut. Volume 68:Issue 10(2019)
• Page Start: 1774
• Page End: 1780
• Publication Date: 2019-02-01
• Subjects: Crohn's disease -- laparoscopic ileocecal resection -- infliximab -- economic evaluation; Gastroenterology -- Periodicals; 616.33
• DOI: 10.1136/gutjnl-2018-317539
• Languages: English
• ISSNs: 0017-5749

Abstract

Abstract : Objective: Evaluate the cost-effectiveness of laparoscopic ileocaecal resection compared with infliximab in patients with ileocaecal Crohn's disease failing conventional therapy. Design: A multicentre randomised controlled trial was performed in 29 centres in The Netherlands and the UK. Adult patients with Crohn's disease of the terminal ileum who failed >3 months of conventional immunomodulators or steroids without signs of critical strictures were randomised to laparoscopic ileocaecal resection or infliximab. Outcome measures included quality-adjusted life-years (QALYs) based on the EuroQol (EQ) 5D-3L Questionnaire and the Inflammatory Bowel Disease Questionnaire (IBDQ). Costs were measured from a societal perspective. Analyses were performed according to the intention-to-treat principle. Missing cost and effect data were imputed using multiple imputation. Cost-effectiveness planes and cost-effectiveness acceptability curves were estimated to show uncertainty. Results: In total, 143 patients were randomised. Mean Crohn's disease total direct healthcare costs per patient at 1 year were lower in the resection group compared with the infliximab group (mean difference €−8931; 95% CI €−12 087 to €−5097). Total societal costs in the resection group were lower than in the infliximab group, however not statistically significant (mean difference €−5729, 95% CI €−10 606 to €172). The probability of resection being cost-effective compared with infliximab was 0.96 at a willingness to pay (WTP) of €0 per QALY gained and per point improvement in IBDQ Score. This probability increased to 0.98 at a WTP of €20 000/QALY gained and 0.99 at a WTP of €500/point of improvement in IBDQ Score. Conclusion: Laparoscopic ileocaecal resection is a cost-effective treatment option compared with infliximab. Clinical trial registration number: Dutch Trial Registry NTR1150; EudraCT number 2007-005042-20 (closed on 14 October 2015).