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, 12, 375-384
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Evaluating the Clinical and Economic Consequences of Using Video Capsule Endoscopy to Monitor Crohn's Disease

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Evaluating the Clinical and Economic Consequences of Using Video Capsule Endoscopy to Monitor Crohn's Disease

Rhodri Saunders et al. Clin Exp Gastroenterol.

Abstract

Background: To assess the cost and patient impact of using small bowel and colon video capsule endoscopy (SBC) for scheduled monitoring of Crohn's disease (CD).

Methods: An individual-patient, decision-analytic model of the CD care pathway was developed given current practice and expert input. A literature review informed clinical endpoints with data from peer-reviewed literature. Four thousand simulated CD patients were extrapolated from summary patient data from the Project Sonar Database. Two monitoring scenarios were assessed in this population. The first scenario represented common monitoring practice (CMP) for CD (ileocolonoscopy plus imaging), while in the second scenario patients were converted to disease monitoring using SBC. The cost-effectiveness of using SBC was assessed over 20 years. The cost of switching 50% of patients to SBC was assessed over 5 years for a health-plan including 12,000 patients with CD. Uncertainty of results was assessed using probabilistic sensitivity analysis.

Results: All patient groups showed increased quality of life with SBC versus CMP, with the highest gain in active symptomatic patients. Over 20 years, SBC reduced costs ($313,367 versus $320,015), increased life expectancy (18.15 versus 17.9 years) and increased quality of life (8.7 versus 8.0 QALY), making it a cost-effective option. SBC was cost-effective in 71% of individuals and 78% of populations including 50 patients. A payer implementing SBC in 50% of patients over 5 years could expect a decreased cost of monitoring (-$469 mean per patient) and surgery (-$698), but increased costs for active treatments (+$717). The discounted mean annual cost of care using CMP was $22,681 per patient over 5 years. The annual savings were $1135 per SBC-patient. The total savings for the payer over 5 years were $36.5 million.

Conclusion: SBC is likely to be a cost-effective and cost-saving strategy for monitoring CD in the US.

Keywords: Crohn’s disease; United States; budget impact; cost-effectiveness; inflammatory bowel disease; video capsule.

Conflict of interest statement

This work was funded by Medtronic. Rhodri Saunders is the owner and Rafael Torrejon Torres an employee of Coreva Scientific GmbH & Co KG, which received consultancy fees as part of this research collaboration. Lawrence Kosinski is a clinician who has ownership in the Sonar MD database and has provided expert input for Allergan Pharmaceuticals and Medtronic. Rhodri Saunders reports consultancy fees from Medtronic, ownership in Coreva Scientific, during the conduct of the study; consultancy fees from Cardinal Health, outside the submitted work; Rafael Torrejon Torres reports personal fees from Medtronic, personal fees from Coreva Scientific, during the conduct of the study; personal fees from Cardinal Health, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Comparison of major surgical outcomes between the model and published literature on Crohn’s disease. Bowel resection after 6 years using CMP (black crosses) is closely aligned to data published by Froslie et al, in initial years showing similarity to patients with mucosal healing and in later years transitioning to data for patients with active disease (A). Over 20 years (B), model data for bowel resection when using CMP (black crosses) and SBC (blue circles) is in line with data presented by Bernstein et al. To 10 years, SBC data most closely resemble that of the most recent clinical data. In both cases, model data are overlaid on figures extracted from the original, referenced publications. Abbreviations: SBC, Small bowel and colon video capsule endoscopy; CMP, Common monitoring practice.
Figure 2
Figure 2
Cost-effectiveness of SBC by group size. The percentage of groups in which SBC would be considered cost-effective at $50,000 USD per QALY gained is shown on the Y-axis, with the group size in question shown on the X-axis. Abbreviation: SBC, Small bowel and colon video capsule endoscopy.
Figure 3
Figure 3
Time to event for use of biologic agents and bowel resection. Time to event data are presented for onset of biologic active treatments for Crohn’s disease (A) and surgery for colonic resection (B). In (A), proportion of patients on treatment by year is shown. In (B), the proportion of patients surgery-free is depicted. Abbreviation: SBC, Small bowel and colon video capsule endoscopy.

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