| Cost-effectiveness Analysis of Adjunct VSL#3 Therapy Versus Standard Medical Therapy in Pediatric Ulcerative Colitis. | |
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MedLine Citation:
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PMID: 21694634 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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BACKGROUND:: Inflammatory bowel diseases (IBD) are costly chronic gastrointestinal diseases, with pediatric IBD representing increased costs per patient compared to adult disease. Healthcare expenditures for ulcerative colitis (UC) are more than 2 billion dollars annually. It is not clear whether the addition of VSL#3 to standard medical therapy in UC induction and maintenance of remission is a cost-effective strategy. METHODS:: We performed a systematic review of the literature, and created a Markov model simulating a cohort of 10 year-old patients with severe UC, following them until 100 years of age or death. We compared two strategies: standard medical therapy vs. medical therapy + VSL#3. For both strategies, we assumed that patients progressed through escalating therapies: mesalamine, azathioprine, and infliximab prior to receiving a colectomy + IPAA if the 3 medical therapy options were exhausted. The primary outcome measure was the incremental cost-effectiveness ratio, defined as the difference of costs between strategies for each quality-adjusted life-year (QALY) gained. One-way sensitivity analyses were performed on variables to determine the key variables impacting cost-effectiveness. RESULTS:: Standard medical care accrued a lifetime cost of $203,317 per patient, compared to $212,582 per patient for medical therapy + VSL#3. Lifetime QALYs-gained was comparable for standard medical therapy and medical therapy + VSL#3 at 24.93 vs. 25.05, respectively. Using the definition of incremental cost-effectiveness ratio (ICER) <50,000/QALY as a cost effective intervention, medical therapy + VSL#3 produced an ICER of $79,910 per QALY-gained, making this strategy cost-ineffective. Sensitivity analyses showed that 4 key parameters could impact the cost-effectiveness of the 2 strategies: cost of colectomy + IPAA, maintenance cost after surgery, probability of developing pouchitis after surgery, and the quality of life after a colectomy + IPAA. High surgical and post-surgical costs, a high probability of developing pouchitis, and a low quality of life after a colectomy + IPAA could make adjunct VSL#3 use a cost-effective strategy. CONCLUSIONS:: Given current data, adjunct VSL#3 use for pediatric UC induction and maintenance of remission is not cost-effective, although several key parameters could make this strategy cost-effective. The quality of life after an IPAA is the single most important variable predicting whether this procedure benefits patients over escalating standard medical therapy. |
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Authors:
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Kt Park; Felipe Perez; Raymond Tsai; Anita Honkanen; Dorsey Bass; Alan Garber |
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Publication Detail:
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Type: JOURNAL ARTICLE Date: 2011-6-17 |
Journal Detail:
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Title: Journal of pediatric gastroenterology and nutrition Volume: - ISSN: 1536-4801 ISO Abbreviation: - Publication Date: 2011 Jun |
Date Detail:
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Created Date: 2011-6-22 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8211545 Medline TA: J Pediatr Gastroenterol Nutr Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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*Stanford University Medical Center, Lucile Packard Children's Hospital, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, USA †Stanford University, School of Medicine, USA ‡Stanford University Medical Center, Lucile Packard Children's Hospital, Department of Anesthesia, USA §Stanford University Medical Center, Center for Health Policy / Primary Care Outcomes Research; VA Palo Alto Health Care Systems, USA. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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