Presentation (CTI)

OBJECTIVES: In Algeria, managing autoimmune diseases is a growing challenge, particularly due to the increasing use of expensive biologic therapies. Crohn’s disease, a representative example, highlights the clinical and economic burden associated with treatment failure, with an estimated incidence of 5.32 per 100,000 and prevalence of 19 per 100,000 in the northeastern region of Algeria. Azathioprine remains the first-line immunosuppressive therapy, but interindividual variability in thiopurine metabolism often leads to inadequate response or adverse effects, resulting in premature treatment escalation. This study aimed to assess the budget impact of introducing systematic monitoring of 6-thioguanine nucleotides (6-TGN) and 6-methylmercaptopurine (6-MMP) to enable treatment personalization and cost containment.
METHODS: A budget impact analysis was conducted over a 5-year horizon (2025-2029) from the public payer’s perspective. Two scenarios were compared:- Scenario 1: current practice without metabolite monitoring;- Scenario 2: implementation of routine metabolite monitoring via LC-MS/MS.
The analysis was based on a 5-year cohort of 13,195 patients. Clinical and economic data were collected from two hospital-based gastroenterology departments, including the costs of treatment, laboratory tests, adverse event management, and escalation to biologics.
RESULTS: Metabolite monitoring reduced the need for biologics (12.9% vs. 21.9%). The cumulative 5-year cost was $18,257,816.64 in Scenario 2 compared to $19,844,568.31 in Scenario 1, resulting in savings of $1,586,878.59. Additionally, the protocol was associated with improved clinical response, fewer side effects, and a lower therapeutic failure rate.
CONCLUSIONS: Implementing metabolite monitoring in Crohn’s disease management could optimize care and reduce costs in Algeria. This personalized approach offers both clinical and economic value, supporting its inclusion in national treatment guidelines.