# Cost Effectiveness of the 8-Strain Probiotic in Primary and Secondary Prophylaxis of Pouchitis

## TL;DR

An 8-strain probiotic is not cost-effective for preventing pouchitis in most cases, but may be cost-effective for patients with frequent relapses.

## Contribution

The study evaluates the cost-effectiveness of an 8-strain probiotic for pouchitis prevention in ulcerative colitis patients.

## Key findings

- The probiotic is not cost-effective for primary prevention of pouchitis.
- It is cost-effective for secondary prevention in patients with frequent relapses.
- No prophylaxis is more cost-effective for infrequent pouchitis relapse prevention.

## Abstract

The 8-strain probiotic formulation appears to be effective for primary and secondary prevention of pouchitis in patients with ulcerative colitis after ileal pouch anal anastomosis. We aimed to study its cost-effectiveness compared to no prophylaxis in these settings.

We constructed decision trees with Markov models for primary prevention of pouchitis and secondary prevention of relapsing pouchitis in patients with ulcerative colitis after ileal pouch anal anastomosis. All patients were followed for 2 years. In the primary prophylaxis model, Markov cycle length was 2 weeks and the pouchitis treatment sequence was ciprofloxacin, metronidazole and a combination of ciprofloxacin and tinidazole. In the secondary prophylaxis models, the Markov cycle length was 4 weeks and the pouchitis treatment sequence was ciprofloxacin, metronidazole, ciprofloxacin/tinidazole, vedolizumab and infliximab. Third-party payers’ perspective with a willingness-to-pay threshold of $100,000/quality-adjusted life years (QALYs) was used. Frequent relapsing pouchitis was defined as ≥2 pouchitis episodes/year.

For primary prevention of pouchitis, no prophylaxis was more cost effective compared with the probiotic prophylaxis on base-case analysis (incremental cost effectiveness ratio $236,661/QALY). On base-case analysis for secondary prevention of pouchitis relapse in infrequent pouchitis, no prophylaxis was more cost effective compared to the probiotic prophylaxis (incremental cost effectiveness ratio $153,011/QALY). One-way sensitivity analysis showed that the probiotic prophylaxis would be the dominant strategy in patients with frequent relapsing pouchitis.

Compared to no prophylaxis, the 8-strain probiotic is not cost-effective for primary prevention of pouchitis. It is cost-effective for secondary prophylaxis of frequent pouchitis but not for secondary prophylaxis of infrequent pouchitis.