Presentation (CTI)

OBJECTIVES: The objective was to evaluate the cost-effectiveness of biologic treatment sequences including guselkumab (GUS), risankizumab (RISA), and vedolizumab (VEDO) in patients with moderate-to-severe Crohn’s disease (CD) following failure of anti-tumor necrosis factor-alpha (TNF-α) inhibitors.
METHODS: A 10-year Markov model was developed from the US healthcare payer’s perspective. Six alternative treatment sequences were compared: (1) GUS-VEDO-RISA, (2) GUS-RISA-VEDO, (3) RISA-GUS-VEDO, (4) RISA-VEDO-GUS, (5) VEDO-GUS-RISA, and (6) VEDO-RISA-GUS. Model inputs were sourced from published evidence and publicly accessible datasets. Model outputs included total healthcare costs and quality-adjusted life-years (QALYs). All costs were adjusted to 2026 US dollars using the Medical Care Consumer Price Index. Both costs and QALYs were discounted at an annual rate of 3%.
RESULTS: Base-case findings indicated that the cost (USD 410,818) and QALY gain (5.016 QALYs) were the lowest with GUS-VEDO-RISA sequence. Three strategies (VEDO-GUS-RISA (USD 415,801 and 5.018 QALYs), GUS-RISA-VEDO (USD 418,913 and 5.028 QALYs), and RISA-VEDO-GUS (USD 763,690 and 5.532 QALYs)) were eliminated due to extended dominance. The remaining non-dominated options, RISA-GUS-VEDO (USD 445,757 and 5.100 QALYs) and VEDO-RISA-GUS (USD 847,209 and 5.699 QALYs), were not deemed cost-effective when the willingness-to-pay (WTP) threshold was set at USD 50,000 per QALY. GUS-VEDO-RISA emerged as the preferred strategy. Deterministic sensitivity analysis indicated that GUS-VEDO-RISA remained the preferred option over variation of all model inputs. Probabilistic analysis showed that GUS-VEDO-RISA was accepted as the preferred option in 93.52% of time at a WTP threshold of USD 50,000 per QALY in 94.65% of simulations at a WTP threshold of USD 150,000 per QALY.
CONCLUSIONS: For patients with moderate-to-severe CD who have failed TNF-α inhibitors, the GUS-VEDO-RISA sequence seems to be the preferred cost-effectiveness option.