Early Surgery Versus Biologic Therapy in Limited Nonstricturing Ileocecal Crohn's Disease—A Decision-making Analysis. Issue 11 (7th January 2020)

• Record Type: Journal Article
• Authors: Broide, Efrat; Eindor-Abarbanel, Adi; Naftali, Timna; Shirin, Haim; Shalem, Tzippora; Richter, Vered; Matalon, Shay; Leshno, Moshe
• Is Part Of: Inflammatory bowel diseases. Volume 26:Issue 11(2020)
• Page Start: 1648
• Page End: 1657
• Publication Date: 2020-01-07
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1093/ibd/izz282
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract: Background: Surgery is the preferred option for patients with symptomatic localized fibrostenotic ileocecal Crohn's disease (CD) but not for those with predominantly active inflammation without obstruction. The benefit of early surgery in patients with a limited nonstricturing ileocecal CD over biologic treatment is still a debate. Objective: Our objective is to formulate a decision analysis model based on recently published data to explore whether early surgery in patients with limited nonstricturing CD is preferred over biologic treatment. Methods: We constructed a Markov model comparing 2 strategies of treatment: (1) early surgery vs (2) biologic treatment. To estimate the quality-adjusted life years (QALYs) and the costs in each strategy, we simulated 10, 000 virtual patients with the Markov model using a Monte Carlo simulation 100 times. Sensitivity analyses were performed to evaluate the robustness of the model and address uncertainties in the estimation of model parameters. Results: The costs were $29, 457 ± $407 and $50, 382 ± $525 (mean ± SD) for early surgery strategy and biologic treatment strategy, respectively. The QALY was 6.24 ± 0.01 and 5.81 ± 0.01 for early surgery strategy and biologic treatment strategy, respectively. Conclusion: The strategy of early surgery dominates (higher QALY value [efficacy] and less cost) compared with the strategy of biologic treatment in patients with limited ileocecal CD. Abstract : The purpose of the article is to construct a Markov model to formulate a decision analysis model based on recently published data to explore whether early surgery in patients with limited nonstricturing Crohn's disease is preferred over biologic treatment.