PMID- 16181376
OWN - NLM
STAT- MEDLINE
DCOM- 20051110
LR  - 20171116
IS  - 0002-9270 (Print)
IS  - 0002-9270 (Linking)
VI  - 100
IP  - 10
DP  - 2005 Oct
TI  - A cost-effectiveness analysis of alternative disease management strategies in 
      patients with Crohn's disease treated with azathioprine or 6-mercaptopurine.
PG  - 2239-47
AB  - BACKGROUND: Azathioprine (AZA) is effective for the maintenance of a steroid free 
      remission in Crohn's disease (CD). Thiopurine methyltransferase (TPMT) is 
      important for the metabolism of AZA and influences the production of active AZA 
      metabolites. AZA dose selection based on pharmacogenetic testing of TPMT and 
      metabolite monitoring (MM) may offer a safety and efficacy advantage over 
      traditional dosing strategies. We performed a decision analysis to estimate the 
      potential costs and effectiveness of TPMT screening and MM as disease management 
      strategies for CD. METHODS: Strategies applying TPMT and/or MM to influence 
      treatment decisions were compared to community care (CC). The impact on toxicity 
      minimization and improved time to initial and sustained response was evaluated. A 
      1-yr model was developed from the third-party payer perspective for mild to 
      moderately chronically active, steroid-treated CD patients. Effectiveness and 
      toxicity defined by time to response CD activity index (CDAI <150, +/- steroids) 
      or time to sustained response (CDAI <150, off steroids x 8 wk) and reduction in 
      leukopenic events, respectively. One- and two-way sensitivity analyses were 
      conducted to determine the effect of varying individual estimates from those used 
      in the base-case analysis. RESULTS: MM, TPMT, and TPMT + MM strategies as 
      compared to CC achieved an earlier time to initial response (18.66, 18.96, and 
      19.10 vs. 22.41 wk, respectively) and sustained response (39.83, 42.91, and 39.8 
      vs. 45.36 wk, respectively). The least costly strategy at 1 yr was TPMT ($3,861) 
      and the most costly strategy was CC ($7,142). Each alternative strategy was shown 
      to dominate CC (i.e., less costs and faster time to response or sustained 
      response). The cost-effectiveness rankings were robust to sensitivity analyses on 
      key variables. CONCLUSION: The addition of alternative strategies to CC may 
      improve AZA outcomes and reduce the total cost of care for steroid treated 
      chronically active CD patients, with TPMT being more beneficial for initial 
      response to treatment and MM being more beneficial for sustained response to 
      treatment.
FAU - Dubinsky, Marla C
AU  - Dubinsky MC
AD  - Department of Pediatrics, Pediatric IBD Center, Cedars-Sinai Medical Center, Los 
      Angeles, CA 90048, USA.
FAU - Reyes, Eileen
AU  - Reyes E
FAU - Ofman, Joshua
AU  - Ofman J
FAU - Chiou, Chiun-Fang
AU  - Chiou CF
FAU - Wade, Sally
AU  - Wade S
FAU - Sandborn, William J
AU  - Sandborn WJ
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Am J Gastroenterol
JT  - The American journal of gastroenterology
JID - 0421030
RN  - 0 (Immunosuppressive Agents)
RN  - E7WED276I5 (Mercaptopurine)
RN  - EC 2.1.1.- (Methyltransferases)
RN  - EC 2.1.1.67 (thiopurine methyltransferase)
RN  - MRK240IY2L (Azathioprine)
SB  - IM
MH  - Azathioprine/administration & dosage/blood/economics
MH  - Community Health Services/*economics
MH  - Cost-Benefit Analysis
MH  - Crohn Disease/drug therapy/*genetics/*metabolism
MH  - Dose-Response Relationship, Drug
MH  - Drug Monitoring/*economics
MH  - Genetic Testing/*economics
MH  - *Health Care Costs
MH  - Humans
MH  - Immunosuppressive Agents/administration & dosage/blood/economics
MH  - Mercaptopurine/administration & dosage/blood/economics
MH  - Methyltransferases/genetics
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2005/09/27 09:00
MHDA- 2005/11/11 09:00
CRDT- 2005/09/27 09:00
PHST- 2005/09/27 09:00 [pubmed]
PHST- 2005/11/11 09:00 [medline]
PHST- 2005/09/27 09:00 [entrez]
AID - AJG41900 [pii]
AID - 10.1111/j.1572-0241.2005.41900.x [doi]
PST - ppublish
SO  - Am J Gastroenterol. 2005 Oct;100(10):2239-47. doi: 
      10.1111/j.1572-0241.2005.41900.x.