Crohn’s & Colitis Congress™

Sessions Speakers Exhibitors Floor Plan Buzz

P206 - ASSESSING THE COST-EFFECTIVENESS OF EPSTEIN-BARR VIRUS SCREENING IN YOUNG MEN INITIATING COMBINATION THERAPY WITH INFLIXIMAB AND AZATHIOPRINE FOR CROHN’S DISEASE (Room Poster Hall)

Introduction: Primary Epstein Barr virus (EBV) infection is associated with developing hemophagocytic lymphohistiocytosis (HLH) with azathioprine use with infliximab (IFX+AZA) but not infliximab monotherapy (IFXm). Experts recommend EBV antibody (EBVAb) screening in young patients and avoiding AZA in EBVAb- patients. We aimed to assess the impact of an EBV screening strategy in young men with Crohn’s disease (CD). Methods: We constructed a Markov model to assess the cost-effectiveness of an EBVAb screening strategy among 16 to 26 year old males with severe CD initiating biologic therapy. We compared two strategies: (1) EBVAb testing (EBVt): EBVAb+ individuals started IFX+AZA, while EBVAb- individuals started IFXm, and (2) Standard of care (SOC): all individuals initiated IFX+AZA without screening. EBVAb- individuals were exposed to a 4% annual risk of EBV infection, resulting in an HLH risk of 0.29/1000 person years with AZA. Age, sex, and AZA use-specific lymphoma was modeled using SEER and CESAME data. In both strategies, IFX failures transitioned to adalimumab. Mean costs, quality adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs) were calculated via First order Monte Carlo simulation of 50 trials of 100,000 individuals at ages 16 to 26 over 1 year. Willingness-to-pay (WTP) thresholds of $50,000 and $100,000 were assessed. Results: Prior to age 26, the SOC strategy yielded greater QALYs but increased costs at 1 year compared to EBVt (Table 1). With a WTP threshold of $50,000, EBVt was preferred in those under age 23 (Figure 1). With a WTP threshold of $100,000, SOC was preferred for all ages. Over 50 trials of 100,000 individuals, 6 cases of HLH occurred. Discussion: Based on this model, a societal EBVAb testing strategy minimizes the risk of HLH but negatively impacts quality of life, likely secondary to reduced use of combination therapy. The SOC strategy is preferred at all ages with a WTP of $100,000 when compared to EBVt.