Cost Utility Analysis of Infliixmab and Adalimumab Compared with Conventional Therapy in Patients with Crohn Disease in the Islamic Republic of Iran

• Published in: Value in health 2017-10, Vol.20 (9), p.A636
• Main Authors: Zaboli, P, Nikfar, S, Kebriaeezadeh, A, Malekzadeh, R, Akbari Sari, A, Sima, A, Abdollahi, M, Mirzaei, S, Sharafkhah, M, Rohani, E
• Format: Article
• Language: English
• Subjects: Computer programs; Cost analysis; Disease; Drug prices; Drugs; Health care expenditures; Human capital; Immunotherapy; Indirect costs; Infliximab; Islam; Monoclonal antibodies; Mortality; Natural history; Patients; Population studies; Prices; Quality adjusted life years; Questionnaires; Sensitivity analysis; Statistical analysis; Systematic review; Therapy; TNF inhibitors; Tumor necrosis factor-α; Utility functions
• ISSN: 1098-3015; 1524-4733
• DOI: 10.1016/j.jval.2017.08.3042

OBJECTIVES: In spite of expensive medication costs of Crohn Disease treatment, an economic evaluation has not been done locally in Islamic Republic of Iran yet, in order to assess this medications cost effectiveness. Therefore, prescribers can^t judge the cost-effective alternative. This study aims to implement a cost utility analysis for two most biologic medications used in severe non Fistulizing Crohn Disease from a societal perspective in Islamic Republic of Iran. METHODS: This study target population was adults' patients with Non Fistulizing Sever Crohn Disease who did not reply to first line therapy. 109 patients were enrolled to study from Shariati Public Hospital and Masoud Clinic which both are referral centers. Study arms included Infliximab and Adalimumab as comparators. Model structure was based on disease natural history and clinicians* consultations. All direct medical and non-medical costs were entered to model. Indirect costs were calculated through Human Capital approach. Patients' utilities were extracted by EQ5D questionnaire through face to face interview. Mortality rates were derived from Iran National Statistics Database. IVansition probabilities were extracted by a systematic review from published Randomized Clinical lYials. A markov model designed with 2 month length cycles and 5 year time horizon in Excel 2013 software. Probabilistic sensitivity analysis was done bylYeeage 2011 software. RESULTS: Calculated Incremental Cost Effectiveness Ratios (ICERs) was -48,469 USD per QALY gained. CONCLUSIONS: Study results showed that due to difference between Infliximab and Adalimumab medications' prices, Adalimumab is the dominant alternative in Islamic Republic of Iran, considering its threshold which is about 3,700 USD. Hence it is recommended that Adalimumab to be administered as the first choice of biologic therapy which is controversial to current approach of/most Iranian gastroenterologists.