Early Surgery Versus Biologic Therapy in Limited Nonstricturing Ileocecal Crohn's Disease-A Decision-making Analysis.

Published on Oct 23, 2020in Inflammatory Bowel Diseases5.325
路 DOI :10.1093/IBD/IZZ282
Efrat Broide24
Estimated H-index: 24
(TAU: Tel Aviv University),
Adi Eindor-Abarbanel3
Estimated H-index: 3
(TAU: Tel Aviv University)
+ 5 AuthorsMoshe Leshno31
Estimated H-index: 31
(TAU: Tel Aviv University)
BACKGROUND: Surgery is the preferred option for patients with symptomatic localized fibrostenotic ileocecal Crohn's disease (CD) but not for those with predominantly active inflammation without obstruction. The benefit of early surgery in patients with a limited nonstricturing ileocecal CD over biologic treatment is still a debate. OBJECTIVE: Our objective is to formulate a decision analysis model based on recently published data to explore whether early surgery in patients with limited nonstricturing CD is preferred over biologic treatment. METHODS: We constructed a Markov model comparing 2 strategies of treatment: (1) early surgery vs (2) biologic treatment. To estimate the quality-adjusted life years (QALYs) and the costs in each strategy, we simulated 10,000 virtual patients with the Markov model using a Monte Carlo simulation 100 times. Sensitivity analyses were performed to evaluate the robustness of the model and address uncertainties in the estimation of model parameters. RESULTS: The costs were 29,457 +/- 07 and 50,382 +/- 25 (mean +/- SD) for early surgery strategy and biologic treatment strategy, respectively. The QALY was 6.24 +/- 0.01 and 5.81 +/- 0.01 for early surgery strategy and biologic treatment strategy, respectively. CONCLUSION: The strategy of early surgery dominates (higher QALY value [efficacy] and less cost) compared with the strategy of biologic treatment in patients with limited ileocecal CD.
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