A model of the long-term cost effectiveness of scheduled maintenance treatment with infliximab for moderate-to-severe ulcerative colitis

Background Infliximab (IFX) has been shown to be efficacious in moderate-severe ulcerative colitis (UC). Aim To evaluate the cost-effectiveness of a scheduled maintenance treatment (SMT) with IFX in moderate-severe UC patients. Methods A Markov model was constructed to simulate the progression of a cohort of moderate-severe UC patients treated with IFX (5 mg/kg) SMT. Transitions were estimated from two phase III trials of IFX (ACT I and ACT II). Standard care, comprising immunomodulators and/or corticosteroids was used as a comparator. Two separate treatment strategies were evaluated - continued treatment in IFX responders and continued treatment in IFX patients achieving remission. The dose of IFX was estimated for a 73 kg typical UC patient in the UK. The results were calculated over 10 years using a discount rate of 3.5% for costs and outcomes. The outcome measure was quality-adjusted life years (QALYs) estimated using EQ-5D. Sensitivity analyses explored the uncertainty around the results. Results The incremental cost effectiveness ratio (ICER) for IFX was 27 pound 424 in the responder strategy and 19 pound 696 in the remission strategy at 10 years. In sensitivity analysis, the ICER for IFX in the responder strategy ranged from 21 pound 066 to 86 pound 322 and in the remission strategy ranged from 14 pound 728 to 46 pound 765. The model time horizon and patient body weight were important factors affecting results. Conclusions Eight-week SMT with IFX appears to be a cost-effective treatment option for adult patients suffering from moderate to severe UC.