Doherty, GlenMiksad, Rebecca A.Cheifetz, AdamMoss, Alan C.2022-07-142012-09-01Doherty, Glen, Rebecca A. Miksad, Adam Cheifetz, Alan C. Moss. "Comparative Cost-Effectiveness of Strategies to Prevent Postoperative Clinical Recurrence of Crohnʼs Disease." Inflammatory Bowel Diseases 18, no. 9 (2012): 1608-1616. DOI: 10.1002/ibd.219041078-09981536-4844https://nrs.harvard.edu/URN-3:HUL.INSTREPOS:37372594Background A number of treatments have been shown to reduce the risk of postoperative recurrence of Crohn's disease (CD). The optimal strategy is unknown. The aim was to evaluate the comparative cost-effectiveness of postoperative strategies to prevent clinical recurrence of CD. Methods Three prophylactic strategies were compared to “no prophylaxis”; mesalamine, azathioprine (AZA) / 6-mercaptopurine (6-MP), and infliximab. The probability of clinical recurrence, endoscopic recurrence, and therapy discontinuation due to adverse drug reactions (ADRs) were extracted from randomized controlled trials (RCTs). Quality-of-life scores and treatment costs were derived from published data. The primary model evaluated quality-adjusted life years (QALYs) and cost-effectiveness at 1 year after surgery. Sensitivity analysis assessed the impact of a range of recurrence rates on cost-effectiveness. An exploratory analysis evaluated cost-effectiveness outcomes 5 years after surgery. Results A strategy of “no prophylaxis” was the least expensive one at 1 and 5 years after surgery. Compared to this approach, AZA/6-MP had the most favorable incremental cost-effectiveness ratio (ICER) (USD 299,188/QALY gained), and yielded the highest net health benefits of the medication strategies at 1 year. Sensitivity analysis determined that the ICER of AZA/6-MP was preferable to mesalamine up to a recurrence rate of 52%, but mesalamine dominated at higher rates. In the 5-year exploratory analysis, mesalamine had the most favorable ICER over 5 years (USD 244,177/QALY gained). Conclusions Compared to no prophylactic treatment, AZA/6-MP has the most favorable ICER in the prevention of clinical recurrence of postoperative CD up to 1 year. At 5 years, mesalamine had the most favorable ICER in this model.en-USGastroenterologyImmunology and AllergyJournal Article2017-09-1420122022-07-1410.1002/ibd.21904