JCC: 与戒断治疗相比,缓解期溃疡性结肠炎患者继续使用抗TNF药物并不划算

2020-11-22 MedSci原创 MedSci原创

抗肿瘤坏死因子α(抗TNF)治疗占与溃疡性结肠炎(UC)相关的医疗保健支出的31%。缓解期溃疡性结肠炎(UC)患者停用抗TNF可以减少副作用和感染,同时减少医疗成本支出。

背景和目标

抗肿瘤坏死因子α(抗TNF)治疗占与溃疡性结肠炎(UC)相关的医疗保健支出的31%。缓解期溃疡性结肠炎(UC)患者停用抗TNF可以减少副作用和感染,同时减少医疗成本支出。约36%的患者在抗TNF撤药后的12至24个月内出现疾病复发,但是80%的患者再次接受治疗可以获得缓解。本项研究旨在评估缓解期UC患者继续使用抗TNF药物与停用抗TNF药物的成本差异。

方法

研究人员开发了一个马尔可夫模型,从医疗保健提供者的角度比较了抗TNF持续治疗和停药的成本效益。

结果

在治疗第5年时,抗TNF撤药的成本较低(每名患者为10781欧元),但比持续治疗的疗效稍差。与停药相比,继续使用抗TNF药物的费用为30390欧元 / 每年,超过了成本效益阈值。如果抗TNF撤药后的复发率提高≥43%,或者阿达木单抗或英夫利昔单抗(生物仿制药)的价格分别降至87/40欧元和66/100欧元以下,那么继续治疗将变得具有成本效益。

结论

与停药相比,缓解期UC患者继续抗TNF治疗没有成本效益。停药后再次引入生物制剂治疗可节省医疗成本,但效果比持续治疗稍差。通过确定复发风险增加的患者,对于低危患者进行停药治疗可以获得更好的经济效益。

原始出处:

Remi Mahmoud. Et al. Continuation of anti-TNF in patients with Ulcerative Colitis in Remission is not Cost-effective compared to Treatment Withdrawal: a Markov Model. Journal of Crohn's and Colitis.2020.

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    2021-08-21 mfx808
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    2021-05-17 nymo
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    2020-11-24 snowpeakxu

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