Funding the New Biologics – A Health Economic Critique of the CCOHTA Report: Infliximab for the Treatment of Crohn’s Disease
Bibliographic record
Abstract
The report of the Canadian Coordinating Office for Health Technology Assessment (CCOHTA) on the use of infliximab in the treatment of refractory Crohn's disease stated that the medication did not meet 'conventional standards of cost-effectiveness'. It had several methodological weaknesses, however, including the derivation of the quality-adjusted life-years (QALYs) gained and the interpretation of the incremental cost utility ratios (ICURs). The validity of economic analyses is highly dependent on the underlying assumptions that are made about the implications of health care states and treatments. The authors of the report mapped utilities from three health states, taken from an American study, onto the nine health states that were considered in their economic analysis. The QALYs that were derived might not have been sensitive to small changes in health outcomes. Moreover, the indirect costs of Crohn's disease and its complications were ignored. Therefore, it is possible that the benefits of infliximab therapy were underestimated. The high ICURs that were quoted in the report do not necessarily mean that infliximab is not valuable, because opportunity costs were not considered. Instead of calculating the ICUR, a preferable approach would be to determine the benefit of this therapy, compared with that which could be derived from alternative uses of the same amount of health care resources. A 'balance sheet' approach would allow decision-makers to determine whether the additional cost of infliximab therapy would be justified by the health care gains that it produces. It is inappropriate to assign an arbitrary cut-off point to cost effectiveness, as defined by ICURs, especially when considering new and expensive treatments for severely ill patients who have few other therapeutic alternatives. Because only a small number of patients would require infliximab, the overall expenditure that would be required to make it available may be manageable.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.085 | 0.322 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.004 | 0.005 |
| Science and technology studies | 0.003 | 0.009 |
| Scholarly communication | 0.011 | 0.006 |
| Open science | 0.005 | 0.005 |
| Research integrity | 0.025 | 0.031 |
| Insufficient payload (model declined to judge) | 0.005 | 0.002 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".