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Mesenchymal Stem/Stromal Cell Therapy Is More Cost-Effective Than Fecal Diversion for Treatment of Perianal Crohn’s Disease Fistulas

Crohn’s disease (CD) is an inflammatory bowel disease with increasing incidence and prevalence worldwide. Perianal fistulas are seen in up to 26% of CD patients and are often refractory to medical therapy. Current treatments for CD perianal fistulas (pCD) include antibiotics, biologics, and for refr...

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Autores principales: Johnson, Sheeva, Hoch, Jeffrey S., Halabi, Wissam J., Ko, Jeffrey, Nolta, Jan, Dave, Maneesh
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9248358/
https://www.ncbi.nlm.nih.gov/pubmed/35784367
http://dx.doi.org/10.3389/fimmu.2022.859954
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author Johnson, Sheeva
Hoch, Jeffrey S.
Halabi, Wissam J.
Ko, Jeffrey
Nolta, Jan
Dave, Maneesh
author_facet Johnson, Sheeva
Hoch, Jeffrey S.
Halabi, Wissam J.
Ko, Jeffrey
Nolta, Jan
Dave, Maneesh
author_sort Johnson, Sheeva
collection PubMed
description Crohn’s disease (CD) is an inflammatory bowel disease with increasing incidence and prevalence worldwide. Perianal fistulas are seen in up to 26% of CD patients and are often refractory to medical therapy. Current treatments for CD perianal fistulas (pCD) include antibiotics, biologics, and for refractory cases, fecal diversion (FD) with ileostomy or colostomy. Mesenchymal stem/stromal cell therapy (MSCs) is a new modality that have shown efficacy in treating pCD. MSCs locally injected into pCD can lead to healing, and a phase III clinical trial (ADMIRE-CD) showed 66% clinical response, leading to approval of MSCs (Alofisel, Takeda) in the European Union. It is unclear if MSCs would be more cost-effective than the current standard of FD. We therefore developed a decision tree model to determine the cost-effectiveness of MSCs compared to FD for pCD. Our study showed that both autologous and allogeneic MSCs are more cost-effective than FD in an academic medical center and even in a worst-case scenario with 100% chance of all complications for MSCs treatment and 0% chance of complications for FD, both allogeneic and autologous MSCs are still cost saving compared to FD.
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spelling pubmed-92483582022-07-02 Mesenchymal Stem/Stromal Cell Therapy Is More Cost-Effective Than Fecal Diversion for Treatment of Perianal Crohn’s Disease Fistulas Johnson, Sheeva Hoch, Jeffrey S. Halabi, Wissam J. Ko, Jeffrey Nolta, Jan Dave, Maneesh Front Immunol Immunology Crohn’s disease (CD) is an inflammatory bowel disease with increasing incidence and prevalence worldwide. Perianal fistulas are seen in up to 26% of CD patients and are often refractory to medical therapy. Current treatments for CD perianal fistulas (pCD) include antibiotics, biologics, and for refractory cases, fecal diversion (FD) with ileostomy or colostomy. Mesenchymal stem/stromal cell therapy (MSCs) is a new modality that have shown efficacy in treating pCD. MSCs locally injected into pCD can lead to healing, and a phase III clinical trial (ADMIRE-CD) showed 66% clinical response, leading to approval of MSCs (Alofisel, Takeda) in the European Union. It is unclear if MSCs would be more cost-effective than the current standard of FD. We therefore developed a decision tree model to determine the cost-effectiveness of MSCs compared to FD for pCD. Our study showed that both autologous and allogeneic MSCs are more cost-effective than FD in an academic medical center and even in a worst-case scenario with 100% chance of all complications for MSCs treatment and 0% chance of complications for FD, both allogeneic and autologous MSCs are still cost saving compared to FD. Frontiers Media S.A. 2022-06-17 /pmc/articles/PMC9248358/ /pubmed/35784367 http://dx.doi.org/10.3389/fimmu.2022.859954 Text en Copyright © 2022 Johnson, Hoch, Halabi, Ko, Nolta and Dave https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Immunology
Johnson, Sheeva
Hoch, Jeffrey S.
Halabi, Wissam J.
Ko, Jeffrey
Nolta, Jan
Dave, Maneesh
Mesenchymal Stem/Stromal Cell Therapy Is More Cost-Effective Than Fecal Diversion for Treatment of Perianal Crohn’s Disease Fistulas
title Mesenchymal Stem/Stromal Cell Therapy Is More Cost-Effective Than Fecal Diversion for Treatment of Perianal Crohn’s Disease Fistulas
title_full Mesenchymal Stem/Stromal Cell Therapy Is More Cost-Effective Than Fecal Diversion for Treatment of Perianal Crohn’s Disease Fistulas
title_fullStr Mesenchymal Stem/Stromal Cell Therapy Is More Cost-Effective Than Fecal Diversion for Treatment of Perianal Crohn’s Disease Fistulas
title_full_unstemmed Mesenchymal Stem/Stromal Cell Therapy Is More Cost-Effective Than Fecal Diversion for Treatment of Perianal Crohn’s Disease Fistulas
title_short Mesenchymal Stem/Stromal Cell Therapy Is More Cost-Effective Than Fecal Diversion for Treatment of Perianal Crohn’s Disease Fistulas
title_sort mesenchymal stem/stromal cell therapy is more cost-effective than fecal diversion for treatment of perianal crohn’s disease fistulas
topic Immunology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9248358/
https://www.ncbi.nlm.nih.gov/pubmed/35784367
http://dx.doi.org/10.3389/fimmu.2022.859954
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