P577 Cost-effectiveness of episodic or maintenance infliximab versus standard treatment in an incidence cohort of Crohn's disease patients with 10-years follow-up

S242 in all study groups (105.8% vs 114.3% RDA in normal controls; 88.7% vs 109.2% RDA in diseased controls, 100.4% vs 87.6% RDA in IBD. Conclusions: In this study IBD patients had a significantly lower Ca intake than healthy controls. In accordance to previous studies, gender and age, more than diagnosis, are relevant factors in determining inadequate Ca intake. The trend is more marked in IBD, especially in postmenopausal women. Selfreported lactose intolerance, leading to dietary restrictions, is the single major determinant of low Ca intake in all pts groups, irrespective to diagnosis, age and gender. Inadequate Ca intake is observed in about one third of IBD pts and represents an easily reversible risk factor for osteoporosis. The observation that celiac patients on low gluten diet have a Ca intake well over RDA, further supports the need for tailored nutrition advice also in ulcerative colitis and Crohn’s disease. P577 Cost-effectiveness of episodic or maintenance infliximab versus standard treatment in an incidence cohort of Crohn’s disease patients with 10-years follow-up S. Odes1 , D. Greenberg2 , H. Vardi3 , M. Friger3 , R. Stockbrugger4 , P. Munkholm5 *. 1 Soroka Medical Center and Ben Gurion University of the Negev, Gastorenterology and Hepatology, Beer Sheva, Israel, 2 Ben Gurion University of the Negev, Health Systems Management, Beer Sheva, Israel, 3 Ben Gurion University of the Negev, Epidemiology, Beer Sheva, Israel, 4 Maastricht University Hospital, Gastroenterology and Hepatology, Maastricht, Netherlands, 5 University of Copenhagen and Herlev Hospital, Gastroenterology, Copenhagen, Denmark Background: Infliximab is indicated in Crohn’s disease resistant to standard treatment with antibiotics, mesalazine, corticosteroids and immunomodulators), and was shown to reduce the need for hospitalization and surgery. Whether this is enough to offset its high acquisition price is unknown, and the impact of infliximab on healthcare-cost and quality-adjusted life-expectancy is incompletely understood. Previous studies using mathematical models failed to demonstrate cost savings. We sought to determine the cost-effectiveness of infliximab in a real life cohort of Crohn’s disease patients, using episodic and maintenance infliximab treatment and calculating their cost-effectiveness versus standard treatment and versus each other. Methods: 212 incident adult CD patients (age at onset 34.4±14.5 years, 49.4% male) had received standard treatment over 10-years to 2004. We defined 8 health states (by intensity of treatment) and their Markov transition probabilities, healthcare costs and quality-adjusted life years (QALYs) in 3-month-cycles. The cohort was modeled to allow infliximab treatment as episodic treatment (one cycle) or maintenance treatment for 1-year (MT-1yr) or 10-years (MT-10yr), using current clinical criteria for biologic treatment. Healthcare-cost (3% discount) and QALYs in episodic treatment and maintenance treatment were estimated for 10-years and compared with standard treatment and with each other. Results: The average cost in EUROS (QALYs gained) per patient over 10-years was 23,169 (6.7014) for standard treatment; 21,691 (7.0403) for episodic treatment, 29,012 (7.0553) for MT-1yr, and 50,416 (7.2603) for MT-10 yr. Standard treatment was dominated by episodic treatment. The incremental costeffectiveness ratios (ICERs) of MT-1yr or MT-10 yr over standard treatment were 16,510/QALY or 48,751/QALY. When compared with episodic treatment, the ICERs of MT-1yr and MT-10 yrs were 488,066/QALY, and 130,568/QALY, respectively. Conclusions: Episodic treatment or maintenance treatment with infliximab are either cost-saving or cost-effective when compared with standard treatment. However, at current drug prices, maintenance treatment does not provide good value for

Poster presentations money when compared with episodic treatment. Reduction of the price of infliximab will serve to alter this finding. P578 C-reactive protein levels at first month of adalimumab treatment as predictive of nonresponse in Crohn’s disease patients E. Rodrigues-Pinto1 *, F. Magro1 , F. Vilas-Boas1 , J. SantosAntunes1 , A. Nunes1 , S. Lopes1 , C. Dias2 , G. Macedo1 . 1 Centro Hospitalar S˜ ao Jo˜ ao, Faculdade Medicina Universidade Porto, Gastroenterology department, Porto, Portugal, 2 Faculdade Medicina Universidade Porto, Health Decision and Information Science Department, Porto, Portugal Background: Adalimumab (ADA) is effective in treating Crohn’s disease (CD) and C-reactive protein (CRP) is a useful biomarker in assessing inflammatory activity. Our aim is to correlate CRP levels and CRP variations during the first year of treatment with ADA in patients who started it due to luminal disease. Methods: Cross sectional study of CD patients who started treatment with ADA due to luminal disease (patients with perianal disease or post-operative recurrence as an indication for treatment were excluded). Seventy-three patients with CD were evaluated (6.5 CRP measurements per patient). Primary nonresponse (PNR) was defined as no symptomatic improvement and CRP persistently elevated; sustained response (SR) as symptomatic improvement for at least 1 year without therapeutic adjustment; response after therapeutic adjustment (RTA) as analytic and clinical response but requiring IFX dose/frequency adjustment or association with another drug. Results: Non-stenosing and non-penetrating behaviour was statistically significant associated with sustained response (p = 0.044). Previous Infliximab treatment did not influence CRP response (p = 0.230), as well, as previous surgery (p = 0.095), however, there was a tendency towards SR when no surgery was performed. Baseline CRP levels were higher in PNR compared with SR (32 mg/L vs 21.4 mg/L) and RTA (32 mg/L vs 26.5 mg/L), however no significance was reached (p = 0.076). CRP levels were statistically significant at 1st, 4th, 5th, 6th, 11th and 12th month, being significantly higher in PNR compared to SR and RTA, however no differences were found between SR and RTA. During first year of treatment, CRP levels were in median 30.23 mg/L higher in PNR regarding SR ([11.204;49.251], p = 0.002) and 24.55 mg/L regarding RTA ([4.766;44.338], p = 0.015). CRP levels were 5.67 mg/L lower in SR regarding RTA, but no significance was found ([ 12.13; 0.78], p = 0.085). In all groups there was a median 0.015 CRP decrease, measurement to measurement ([ 0.767; 0.738], p = 0.969), but not statistically significant. Conclusions: CRP levels correlate with the pattern of response to ADA in CD. High inflammatory burden during ADA treatment is correlated with a worse response. First month is an important timepoint in evaluating who won’t response to ADA. P579 Bowel damage after biological therapy assessed by Sonographic Lesion Index for Crohn’s disease F. Zorzi1 *, S. Zuzzi2 , E. Stasi1 , G. Bevivino1 , C. Petruzziello1 , L. Biancone1 , C. Rossi2 , F. Pallone1 , E. Calabrese1 . 1 University of Rome Tor Vergata, GI Unit, Medicine, Rome, Italy, 2 University of Rome Tor Vergata, Centro Interdipartimentale di Biostatistica e Bioinformatica, Rome, Italy Background: Anti-TNFs have shown efficacy in Crohn’s disease (CD). Mucosal healing represents a surrogate marker for this efficacy but the effects on structural damage are still poorly known. Small intestine contrast ultrasonography (SICUS) is a valuable tool for assessing CD lesions. A new sonographic quantitative index (SLIC: Sonographic Lesion Index for CD) was