Real-World Cost-Effectiveness Analysis of Ustekinumab-Based Therapies Vs Non-Biologic Therapies for Moderate to Severe Crohn’s Disease in Chinese Population

OBJECTIVES: Due to the fluctuating nature of Crohn's disease, which alternates between active and remission phases, the treatment goal is to keep patients in a state of disease remission. We develop a decision-analytic model to evaluate the long-term cost-effectiveness of Ustekinumab-based therapies (UST group) compared to non-biologic therapies (conventional group) based on real-world study.

METHODS: During the period spanning from January 2020 to September 2022, a cohort of patients afflicted with moderate to severe Crohn's disease (MS-CD) was assembled at a tertiary care institution in China. Clinical outcomes and related medical costs were collected to compare UST group with conventional group over a 1-year observation time. Subsequently, a cost effectiveness model was constructed, utilizing the resultant empirical data, to rigorously assess the cost-effectiveness of UST group in relation to conventional group.

RESULTS: Based on the included 430 patients, UST group significantly improves disease remission rates, reduces surgical incidence, and has higher inpatient management fees compared to conventional group. From the perspective of the Chinese healthcare system, UST group yields a total of 9.37 Quality-Adjusted Life Years (QALYs) at a direct medical cost of ¥273,397, whereas conventional group results in 7.93 QALYs with a direct medical cost of ¥200,727. The Incremental Cost-Effectiveness Ratio (ICER) stands at ¥50,467. When considering non-medical costs, UST group exhibits a lower cost and superior efficacy, thus demonstrating dominant advantage. The result also showed that UST group has lower induction times(6.96 vs 23.73) and surgery times(0.37 vs 2.23).

CONCLUSIONS: UST group significantly improved real-world health outcomes at a cost to the Chinese public healthcare system of less than one 1x 2022 Chinese gdp per capita per gained QALY in Chinese MS-CD patients.