Biological therapies in Crohn’s disease: are they cost-effective? A critical appraisal of model-based analyses

Abstract

In refractory Crohn’s disease, anti-TNF and anti-α 4 integrin agents are used for ameliorating disease activity but impose high costs to health-care systems. The authors systematically reviewed cost–effectiveness analyses based on decision models: most of the studies were judged to have a good quality, but a large portion assessed health and costs in a short time horizon, usually disregarding fistulizing disease and not considering safety. Infliximab induction followed by on-demand retreatment consistently proved to have a good cost per quality-adjusted life year, while maintenance treatment never satisfied commonly accepted cost-utility thresholds. Challenges in cost–effectiveness analysis include the lack of a standard model structure, a large variability in the costs of surgery and poor data on indirect costs. As clinical practice is moving to mucosal healing as a robust response marker, personalized schedules of anti-TNF therapies might prove cost-effective even in the perspective of the health-care system in the near future.

Keywords::

• cost–effectiveness analysis
• crohn’s disease
• decision analysis
• health economics
• inflammatory bowel disease

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Several effective biological therapies are available for Crohn’s disease (CD), but optimal scheduling and sequence has not been ascertained yet.

• Monoclonal antibodies for CD provide quality-of-life amelioration at an acceptable cost for value if maintenance therapy is tailored, an appropriate time horizon is adopted and societal costs are considered.

• Mucosal healing is a candidate intermediate end point for personalizing therapies for CD: future decision models should consider estimation of long-term outcomes based on such a parameter.

• Standard model structure and main input parameters should be centrally defined in order to allow full comparability among model-based cost–effectiveness studies.