Cost-utility of initial medical management for Crohn's disease perianal fistulae

(Background & Aims) under bar: The cost-utility of infliximab is unknown, T he aim of this study was to determine the incremental cost-utility (CUinc) of medical therapy for Crohn's disease (CD) perianal fistula, (Methods) und er bar: A Marhov model was used to simulate a 1-year treatment period with the following: 6-mercaptopurine and metronidazole [6MP/met] (comparator), 3 infliximab infusions + 6MP/met as second-line therapy (intervention I), in fliximab with episodic reinfusion (intervention II), and 6MP/met + inflixim ab as second-line therapy (intervention III). Utilities were elicited from patients with CD and healthy individuals by standard gamble, and costs were obtained from hospital billing data. Uncertainty was assessed by sensitivi ty analysis, (Results) under bar: All strategies had similar effectiveness. Interventions I, II, and III were slightly more effective, but also more c ostly than 6MP/met (Intervention I: CUinc = $355,450/quality-adjusted life- years [QALY]; Intervention II: CUinc = $360,900/QALY; Intervention III: CUi nc = $377,000/QALY). If the cost of infliximab were reduced to $304 per inf usion, the CUinc for intervention II would be $54,050/QALY. (Conclusions) u nder bar: Based on available data, all strategies had similar effectiveness in our model, but infliximab was much more expensive than 6MP/met. The inc remental benefit of infliximab for treating CD perianal fistulae over a 1-y ear period may not justify the higher cost. Prospective studies directly co mparing 6MP/met and infliximab are warranted.