Disease Burden of Moderate to Severe Crohn’S Disease UNDER Current Treatment Pattern in China

OBJECTIVES : To estimate the disease burden of moderate to severe Crohn's disease (MS-CD) under current treatment pattern in China.

METHODS : A decision-analytic model was constructed to simulate the Chinese patients with MS-CD and the age and gender-matched Chinese general population over lifetime time horizon for the differences in overall survival, quality-adjusted life years (QALYs), and lifetime direct medical costs. Literature search was conducted to identify appropriate evidence to estimate the model variables. Base case analysis and sensitivity analysis were conducted for the point estimations and uncertainty of the disease burden of MS-CD.

RESULTS : The Chinese MS-CD patients were associated with reduced average overall survival by 2.221 years (42.794 years vs. 45.014 years), reduced average QALY by 7.666 QALY (34.063 QALY vs. 41.768 QALY), and increased average life-time direct medical costs by ¥681,910 (¥893,807 vs. ¥211,897). The reduced QALY associated with MS-CD was highly sensitive to quality of life of disease remission (change: 12.079 QALYs) and active disease (change: 1.009 QALYs) , mortality of active disease (change:-1.280 QALYs), and treatment effect of infliximab for induction therapy (change: 0.939) and immunosuppressants for maintenance therapy (change: -0.905). The lifetime direct medical costs associated with MS-CD was highly sensitive to administration of infliximab for maintenance therapy (change: ¥426,022), compliance of infliximab (change: ¥-347,445), drug acquisition costs of infliximab (change: ¥244,187), and hospital costs associated with active disease (change: ¥211,009). The probabilistic sensitivity analysis with 5,000 Monte Carlo simulations estimated the median and 95% credible interval of reduced QALY ( -7.076 QALY, -15.136 to -3.186 QALY) and increased lifetime direct medical costs (¥694,054, ¥363,376 to ¥1,215,003).

CONCLUSIONS : The disease burden of MS-CD in Chinese patients was mainly characterized with reduced QALY and increased medical costs that were highly sensitive to quality of life, infliximab treatment, and activity disease .