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Infliximab versus ciclosporin in steroid resistant acute severe ulcerative colitis: a model-based cost-utility analysis of data from CONSTRUCT pragmatic trial

Mohammed Fasihul Alam, Mirella Longo, David Cohen, Samantha Groves, Laith Alrubaiy Orcid Logo, Hayley Hutchings Orcid Logo, Alan Watkins Orcid Logo, Shaji Sebastain, John Williams

BMC Health Services Research, Volume: 23, Issue: 1

Swansea University Authors: Samantha Groves, Laith Alrubaiy Orcid Logo, Hayley Hutchings Orcid Logo, Alan Watkins Orcid Logo, John Williams

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DOI (Published version): 10.1186/s12913-023-09233-w

Abstract

BackgroundThere is limited evidence in the literature on the long-term effectiveness and cost-effectiveness of treatments for Acute Severe Ulcerative Colitis (ASUC). The study aimed to perform decision analytic model-based long-term cost-utility analysis (CUA) of infliximab versus ciclosporin for st...

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Published in: BMC Health Services Research
ISSN: 1472-6963
Published: Springer Science and Business Media LLC 2023
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URI: https://cronfa.swan.ac.uk/Record/cronfa62906
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The study aimed to perform decision analytic model-based long-term cost-utility analysis (CUA) of infliximab versus ciclosporin for steroid-resistant ASUC investigated in CONSTRUCT pragmatic trial.MethodsA decision tree (DT) model was developed using two-year health effect, resource use and costs data from CONSTRUCT trial to estimate relative cost-effectiveness of two competing drugs from the United Kingdom (UK) National Health Services (NHS) perspective. Using short-term trial data, a Markov model (MM) was then developed and evaluated over further 18 years. Both DT and MM were combined to investigate cost-effectiveness of infliximab versus ciclosporin for ASUC patients over 20-year time horizon, with a rigorous multiple deterministic and probabilistic sensitivity analyses to address uncertainty in results.ResultsThe decision tree mirrored trial-based results. Beyond 2-year trial follow-up, Markov model predicted a decrease in colectomy rate, but it remained slightly higher for ciclosporin. NHS costs and quality adjusted life years (QALYs) over base-case 20 year time horizon were &#xA3;26,793 and 9.816 for ciclosporin and &#xA3;34,185 and 9.106 for infliximab, suggesting ciclosporin dominates infliximab. Ciclosporin had 95% probability of being cost-effective at a willingness-to-pay (WTP) threshold value up to &#xA3;20,000.ConclusionUsing data from a pragmatic RCT, the cost-effectiveness models produced incremental net health benefit in favour of ciclosporin relative to infliximab. Results from long-term modelling indicated that ciclosporin remains dominant compared with infliximab for the treatment of NHS ASUC patients, however, these need to be interpreted cautiously.</abstract><type>Journal Article</type><journal>BMC Health Services Research</journal><volume>23</volume><journalNumber>1</journalNumber><paginationStart/><paginationEnd/><publisher>Springer Science and Business Media LLC</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1472-6963</issnElectronic><keywords>Ulcerative colitis; Infliximab; Ciclosporin; Cost-effectiveness; Decision tree; Markov model</keywords><publishedDay>8</publishedDay><publishedMonth>3</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-03-08</publishedDate><doi>10.1186/s12913-023-09233-w</doi><url/><notes/><college>COLLEGE NANME</college><CollegeCode>COLLEGE CODE</CollegeCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders>Open Access funding provided by the Qatar National Library. 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This article is licensed under a Creative Commons Attribution 4.0 International License.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling 2025-06-05T14:18:25.4853244 v2 62906 2023-03-10 Infliximab versus ciclosporin in steroid resistant acute severe ulcerative colitis: a model-based cost-utility analysis of data from CONSTRUCT pragmatic trial eb642e3823a000ee7550db9c062c2cdb Samantha Groves Samantha Groves true false 62b59abd526b328bbb125dfaa9bdcd6d 0000-0002-6340-8244 Laith Alrubaiy Laith Alrubaiy true false bdf5d5f154d339dd92bb25884b7c3652 0000-0003-4155-1741 Hayley Hutchings Hayley Hutchings true false 81fc05c9333d9df41b041157437bcc2f 0000-0003-3804-1943 Alan Watkins Alan Watkins true false 911a5c03419acf47eab0844e2cd5ab7f John Williams John Williams true false 2023-03-10 BackgroundThere is limited evidence in the literature on the long-term effectiveness and cost-effectiveness of treatments for Acute Severe Ulcerative Colitis (ASUC). The study aimed to perform decision analytic model-based long-term cost-utility analysis (CUA) of infliximab versus ciclosporin for steroid-resistant ASUC investigated in CONSTRUCT pragmatic trial.MethodsA decision tree (DT) model was developed using two-year health effect, resource use and costs data from CONSTRUCT trial to estimate relative cost-effectiveness of two competing drugs from the United Kingdom (UK) National Health Services (NHS) perspective. Using short-term trial data, a Markov model (MM) was then developed and evaluated over further 18 years. Both DT and MM were combined to investigate cost-effectiveness of infliximab versus ciclosporin for ASUC patients over 20-year time horizon, with a rigorous multiple deterministic and probabilistic sensitivity analyses to address uncertainty in results.ResultsThe decision tree mirrored trial-based results. Beyond 2-year trial follow-up, Markov model predicted a decrease in colectomy rate, but it remained slightly higher for ciclosporin. NHS costs and quality adjusted life years (QALYs) over base-case 20 year time horizon were £26,793 and 9.816 for ciclosporin and £34,185 and 9.106 for infliximab, suggesting ciclosporin dominates infliximab. Ciclosporin had 95% probability of being cost-effective at a willingness-to-pay (WTP) threshold value up to £20,000.ConclusionUsing data from a pragmatic RCT, the cost-effectiveness models produced incremental net health benefit in favour of ciclosporin relative to infliximab. Results from long-term modelling indicated that ciclosporin remains dominant compared with infliximab for the treatment of NHS ASUC patients, however, these need to be interpreted cautiously. Journal Article BMC Health Services Research 23 1 Springer Science and Business Media LLC 1472-6963 Ulcerative colitis; Infliximab; Ciclosporin; Cost-effectiveness; Decision tree; Markov model 8 3 2023 2023-03-08 10.1186/s12913-023-09233-w COLLEGE NANME COLLEGE CODE Swansea University Another institution paid the OA fee Open Access funding provided by the Qatar National Library. The CONSTRUCT trial was funded by the NIHR Health Technology Assessment programme (project no. 06/78/03). 2025-06-05T14:18:25.4853244 2023-03-10T12:18:44.0621936 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Mohammed Fasihul Alam 1 Mirella Longo 2 David Cohen 3 Samantha Groves 4 Laith Alrubaiy 0000-0002-6340-8244 5 Hayley Hutchings 0000-0003-4155-1741 6 Alan Watkins 0000-0003-3804-1943 7 Shaji Sebastain 8 John Williams 9 62906__26807__7b622e20281b4be184ac1a593ced545e.pdf Alam_et_al-2023-BMC_Health_Services_Research.pdf 2023-03-10T12:27:30.9821198 Output 1418039 application/pdf Version of Record true © The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License. true eng http://creativecommons.org/licenses/by/4.0/
title Infliximab versus ciclosporin in steroid resistant acute severe ulcerative colitis: a model-based cost-utility analysis of data from CONSTRUCT pragmatic trial
spellingShingle Infliximab versus ciclosporin in steroid resistant acute severe ulcerative colitis: a model-based cost-utility analysis of data from CONSTRUCT pragmatic trial
Samantha Groves
Laith Alrubaiy
Hayley Hutchings
Alan Watkins
John Williams
title_short Infliximab versus ciclosporin in steroid resistant acute severe ulcerative colitis: a model-based cost-utility analysis of data from CONSTRUCT pragmatic trial
title_full Infliximab versus ciclosporin in steroid resistant acute severe ulcerative colitis: a model-based cost-utility analysis of data from CONSTRUCT pragmatic trial
title_fullStr Infliximab versus ciclosporin in steroid resistant acute severe ulcerative colitis: a model-based cost-utility analysis of data from CONSTRUCT pragmatic trial
title_full_unstemmed Infliximab versus ciclosporin in steroid resistant acute severe ulcerative colitis: a model-based cost-utility analysis of data from CONSTRUCT pragmatic trial
title_sort Infliximab versus ciclosporin in steroid resistant acute severe ulcerative colitis: a model-based cost-utility analysis of data from CONSTRUCT pragmatic trial
author_id_str_mv eb642e3823a000ee7550db9c062c2cdb
62b59abd526b328bbb125dfaa9bdcd6d
bdf5d5f154d339dd92bb25884b7c3652
81fc05c9333d9df41b041157437bcc2f
911a5c03419acf47eab0844e2cd5ab7f
author_id_fullname_str_mv eb642e3823a000ee7550db9c062c2cdb_***_Samantha Groves
62b59abd526b328bbb125dfaa9bdcd6d_***_Laith Alrubaiy
bdf5d5f154d339dd92bb25884b7c3652_***_Hayley Hutchings
81fc05c9333d9df41b041157437bcc2f_***_Alan Watkins
911a5c03419acf47eab0844e2cd5ab7f_***_John Williams
author Samantha Groves
Laith Alrubaiy
Hayley Hutchings
Alan Watkins
John Williams
author2 Mohammed Fasihul Alam
Mirella Longo
David Cohen
Samantha Groves
Laith Alrubaiy
Hayley Hutchings
Alan Watkins
Shaji Sebastain
John Williams
format Journal article
container_title BMC Health Services Research
container_volume 23
container_issue 1
publishDate 2023
institution Swansea University
issn 1472-6963
doi_str_mv 10.1186/s12913-023-09233-w
publisher Springer Science and Business Media LLC
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
document_store_str 1
active_str 0
description BackgroundThere is limited evidence in the literature on the long-term effectiveness and cost-effectiveness of treatments for Acute Severe Ulcerative Colitis (ASUC). The study aimed to perform decision analytic model-based long-term cost-utility analysis (CUA) of infliximab versus ciclosporin for steroid-resistant ASUC investigated in CONSTRUCT pragmatic trial.MethodsA decision tree (DT) model was developed using two-year health effect, resource use and costs data from CONSTRUCT trial to estimate relative cost-effectiveness of two competing drugs from the United Kingdom (UK) National Health Services (NHS) perspective. Using short-term trial data, a Markov model (MM) was then developed and evaluated over further 18 years. Both DT and MM were combined to investigate cost-effectiveness of infliximab versus ciclosporin for ASUC patients over 20-year time horizon, with a rigorous multiple deterministic and probabilistic sensitivity analyses to address uncertainty in results.ResultsThe decision tree mirrored trial-based results. Beyond 2-year trial follow-up, Markov model predicted a decrease in colectomy rate, but it remained slightly higher for ciclosporin. NHS costs and quality adjusted life years (QALYs) over base-case 20 year time horizon were £26,793 and 9.816 for ciclosporin and £34,185 and 9.106 for infliximab, suggesting ciclosporin dominates infliximab. Ciclosporin had 95% probability of being cost-effective at a willingness-to-pay (WTP) threshold value up to £20,000.ConclusionUsing data from a pragmatic RCT, the cost-effectiveness models produced incremental net health benefit in favour of ciclosporin relative to infliximab. Results from long-term modelling indicated that ciclosporin remains dominant compared with infliximab for the treatment of NHS ASUC patients, however, these need to be interpreted cautiously.
published_date 2023-03-08T13:32:44Z
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