Evidence map›Paper›PMID 36890533›Full record

Trial reportBMC health services research2023

Infliximab versus ciclosporin in steroid resistant acute severe ulcerative colitis: a model-based cost-utility analysis of data from CONSTRUCT pragmatic trial.

Mohammed Fasihul Alam, Mirella Longo, David Cohen, Sam Groves, Laith Alrubaiy, Hayley A Hutchings, Alan Watkins, Shaji Sebastain, John G Williams

Open access · goldAbstract readPragmatic Clinical TrialRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC health services research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
0.6field-weighted citation impact, top 25% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 2 citations in OpenAlex.

  1. Article
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 5 institutions in 2 countries.

Mohammed Fasihul AlamDepartment of Public Health, College of Health Sciences, QU-Health, Qatar University, PO Box 2713, Doha, Qatar. malam@qu.edu.qa.
Mirella LongoMarie Curie Palliative Care Research Centre, Cardiff University, 8th Floor Neuadd Meirionnydd, Heath Park Way, Cardiff, CF14 4YS, UK.
David CohenFaculty of Health, Sport and Professional Practice, University of South Wales, Lower Glyntaff, Pontypridd, CF37 1DL, UK.
Sam GrovesSwansea Centre for Health Economics, College of Health and Human Sciences, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
Laith AlrubaiySwansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
Hayley A HutchingsSwansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
Alan WatkinsSwansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
Shaji SebastainIBD Unit, Hull University Teaching Hospitals NHS Trust, Hull, UK.
John G WilliamsSwansea University Medical School, Swansea University, Singleton Park, Swansea, SA2 8PP, UK.
Swansea University · GBCardiff University · GBQatar University · QAUniversity of Hull · GBUniversity of South Wales · GB

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThere is limited evidence in the literature on the long-term effectiveness and cost-effectiveness of treatments for Acute Severe Ulcerative Colitis (ASUC). The study aimed to perform decision analytic model-based long-term cost-utility analysis (CUA) of infliximab versus ciclosporin for steroid-resistant ASUC investigated in CONSTRUCT pragmatic trial.

methodsA decision tree (DT) model was developed using two-year health effect, resource use and costs data from CONSTRUCT trial to estimate relative cost-effectiveness of two competing drugs from the United Kingdom (UK) National Health Services (NHS) perspective. Using short-term trial data, a Markov model (MM) was then developed and evaluated over further 18 years. Both DT and MM were combined to investigate cost-effectiveness of infliximab versus ciclosporin for ASUC patients over 20-year time horizon, with a rigorous multiple deterministic and probabilistic sensitivity analyses to address uncertainty in results.

resultsThe decision tree mirrored trial-based results. Beyond 2-year trial follow-up, Markov model predicted a decrease in colectomy rate, but it remained slightly higher for ciclosporin. NHS costs and quality adjusted life years (QALYs) over base-case 20 year time horizon were £26,793 and 9.816 for ciclosporin and £34,185 and 9.106 for infliximab, suggesting ciclosporin dominates infliximab. Ciclosporin had 95% probability of being cost-effective at a willingness-to-pay (WTP) threshold value up to £20,000.

conclusionUsing data from a pragmatic RCT, the cost-effectiveness models produced incremental net health benefit in favour of ciclosporin relative to infliximab. Results from long-term modelling indicated that ciclosporin remains dominant compared with infliximab for the treatment of NHS ASUC patients, however, these need to be interpreted cautiously.

trial registrationCONSTRUCT Trial registration number ISRCTN22663589; EudraCT number: 2008- 001968-36 (Date 27/08/2008).

Indexed as

Colitis, UlcerativeCyclosporineCost-Benefit AnalysisHumansImmunosuppressive AgentsInfliximabQuality-Adjusted Life YearsSteroidsCyclosporineImmunosuppressive AgentsInfliximabSteroidsCiclosporinCost-effectivenessDecision treeInfliximabMarkov modelUlcerative colitis

Identifiers

PMID36890533
PMCPMC9993375
OpenAlexW4323652074

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.