A68 COST EFFECTIVENESS OF TIGHT CONTROL FOR CROHN’S DISEASE WITH ADALIMUMAB-BASED TREATMENT: ECONOMIC EVALUATION OF CALM TRIAL FROM CANADIAN PERSPECTIVE
Bibliographic record
Abstract
Tight control (TC) for Crohn’s disease (CD), using symptoms plus biomarkers (faecal calprotectin, C-reactive protein) to direct adalimumab (ADA) treatment, was associated with improved outcomes and considered cost effective (from United Kingdom setting) compared to clinical management (CM) in a 48-week (wk) multicenter, randomized controlled trial (CALM). This study aims to evaluate the cost-effectiveness (CE) of TC vs CM from Canadian perspective. The CE of TC versus CM was assessed in a Canadian setting. An ordered probit regression estimated CDAI-based health state (remission: CDAI <150, moderate: CDAI ≥150 to <300, severe: CDAI ≥300 to <450, very severe: CDAI ≥450) transition matrices for TC and CM pts; the matrices predicted pt health states weekly over 5 years (yrs). A probit predicted likelihood of hospitalization as a function of health state and randomization to TC or CM. Observed ADA 40mg injections were summed over 48 wk, average injections over wk 23 to 48 were assumed to continue from wk 49 to 260. ADA costs (in Can$) were based on Ontario list price. Health states were associated with health utility and costs related to other direct medical services. Remission rate, CD-related hospitalizations, ADA injections, other direct medical costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) were calculated at 2 and 5 yrs. Work Productivity and Activity Impairment was converted into productivity measures using Canadian average weekly earnings, and probabilistic sensitivity analyses (PSA) were conducted. Over 2 yrs, TC was associated with a higher remission rate (65.3% vs 50.7%), fewer CD-related hospitalizations (0.275 vs 0.720/person yr) and more ADA injections (mean 61.34 vs 46.17) than CM. Total medical costs over 2 yrs were $54,359 and $49,939 for TC and CM; TC had 0.09 higher QALYs (95% confidence interval [CI]: 0.16 to 0.03) and $4,420 higher total medical costs (95% CI: $2,096 to -$12,952). The ICER was $51,150 per QALY (95% CI: $135,451 to -$405,049). PSA simulations indicated 77.2% of the time an ICER was below a cost-per-QALY threshold of $50,000. TC became dominant (i.e., ICER<0) when including the costs associated with work productivity gained (-$16,103 in TC and -$10,713 in CM). The results for 5-yr timeframe were similar, with an ICER of $48,066 in base case and a negative ICER when including work productivity costs. CE of TC improved over time when extrapolating outcomes from CALM in the Canadian setting. Incorporating costs related to work productivity further strengthened the economic value of TC. None
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
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 | 0.004 | 0.011 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.002 | 0.003 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
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".