Proactive vs. Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Disease

Proactive vs. Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Disease

Proactive vs. Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s Disease
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How cost-effective can proactive versus reactive therapeutic drug monitoring be with Crohn's Disease patients who are taking infliximab?

  • Overview

    Proactive Vs Reactive Therapeutic Drug Monitoring of Infliximab in Crohn’s 

    Diana M NegoescuEva A Enns, PhD, Brooke SwanhorstBonnie BaumgartnerJames P CampbellMark T Osterman, MDKonstantinos Papamichael, PhDAdam S Cheifetz, MDByron P Vaughn, MD

    Background: Therapeutic drug monitoring (TDM) is increasingly performed for Infliximab (IFX) in patients with Crohn's disease (CD). Reactive TDM is a cost-effective strategy to empiric IFX dose escalation. The cost-effectiveness of proactive TDM is unknown. The aim of this study is to assess the cost-effectiveness of proactive vs reactive TDM in a simulated population of CD patients on IFX.

    Methods: We developed a stochastic simulation model of CD patients on IFX and evaluated the expected health costs and outcomes of a proactive TDM strategy compared with a reactive strategy. The proactive strategy measured IFX concentration and antibody status every 6 months, or at the time of a flare, and dosed IFX to a therapeutic window. The reactive strategy only did so at the time of a flare.

    Results: The proactive strategy led to fewer flares than the reactive strategy. More patients stayed on IFX in the proactive vs reactive strategy (63.4% vs 58.8% at year 5). From a health sector perspective, a proactive strategy was marginally cost-effective compared with a reactive strategy (incremental cost-effectiveness ratio of $146,494 per quality-adjusted life year), assuming a 40% of the wholesale price of IFX. The results were most sensitive to risk of flaring with a low IFX concentration and the cost of IFX.

    Conclusions: Assuming 40% of the average wholesale acquisition cost of biologic therapies, proactive TDM for IFX is marginally cost-effective compared with a reactive TDM strategy. As the cost of infliximab decreases, a proactive monitoring strategy is more cost-effective.

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