High post-op costs pay off in Crohn’s: POCER

The cost of providing post-operative “active care”  to patients with Crohn’s disease may be high, but new Australian led research suggests it could help prevent recurrence of the disease and reduce costs overall.

In a prospective study published in the World Journal of Gastroenterology, researchers found drug therapy was the major cost component of post-intestinal resection management strategies.

It is part of the Post-Operative Crohn’s Endoscopic Recurrence (POCER) platform of studies which has defined the management of patients with Crohn’s disease following intestinal resection.

Results from the POCER study have already altered treatment algorithms and understanding of drug therapy in the prevention of post-operative recurrence of Crohn’s disease, and has demonstrated that in patients at high risk of recurrence after “curative” surgery for Crohn’s disease, adalimumab prevents recurrent mucosal disease in most patients.

However this is the first time that the cost component has been examined in any great detail.

“To our knowledge, this is the first study to describe healthcare cost profiles in the management of post-operative Crohn’s disease,” the authors wrote.

“The post-operative period is completely different to treating known active disease outside of a surgical episode, the latter being clinically obvious and treatment essential.”

Lead author, Melbourne gastroenterologist Dr Emily Wright said that while it was a small study, it did suggest there could be long-term cost benefits in actively treating patients with biologics or biosimilars.

“It’s something that hasn’t been done before, at least it’s a start and it shows promise,” she said. “And the cost of biologics is reducing by anywhere from 15% to 50%, depending on which country you are in.”

Endoscopic monitoring was also a significant cost in the post-operative Crohn’s disease management strategy, however she said using faecal calprotectin to monitor for disease recurrence could substantially decrease post-operative costs.

Calprotectin levels of 100 or below indicate an absence of inflammation and active disease with an accuracy of about 95%. Those patients returning readings above that should be referred for further investigation by colonoscopy.

“Faecal calprotectin is a good surrogate marker of inflammation, and is less invasive and more cost-effective than endoscopic monitoring,” she told the limbic.

Dr Wright said that adalimumab was not currently PBS-subsidised for use post-operatively, which would add to the cost for patients.

“Certainly this is the sort of data that presents a case for the use of the drug post-operatively, and at some point that may be something that is that taken to the PBS,” she said.

In the meantime, she said the challenge was to find a way to target post-surgery treatment to patients who needed it.

“What we’d really like to be able to do is type patients to see which are most at risk of recurrence (post-surgery), and tailor aggressive active treatment accordingly,” she said.

“Almost certainly we are over treating patients who are not going to have recurrence.”

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