OBJECTIVES

: Biologic agents have shown promise to improve health outcomes for patients with Crohn’s disease (CD); however, uncertainty remains about their optimal use and long-term clinical- and cost-effectiveness. We evaluated the cost-effectiveness of early biologic treatment (≤2 years after diagnosis) compared to late/no biologic use (starting biologics >2 years after diagnosis or no biologic use) for adults with CD in Switzerland.

METHODS

: We developed a Markov cohort model over the patient’s lifetime from the health system and societal perspectives. Transition probabilities, quality of life, and costs for active and remitting disease states were estimated using real world data from the Swiss Inflammatory Bowel Disease Cohort Study and reimbursement claims. Propensity score matching was used to ensure comparability between the treatment (early biologic use) and comparator (late/no biologic use) groups. The incremental cost-effectiveness ratio (ICER) per quality-adjusted life year (QALY) is reported in Swiss francs (CHF). Sensitivity and scenario analyses were performed.

RESULTS

: Total costs and QALYs were higher for early (CHF 384,607; 16.84 QALYs) compared to late/no biologic use (CHF 340,800; 16.75 QALYs). ICERs were CHF 887,450 per QALY and CHF 449,130 per QALY from the health system and societal perspectives, respectively. ICERs were below the assumed threshold of CHF 100,000 per QALY in 10% (health system) and 25% (societal) of simulations in probabilistic sensitivity analysis. The cost-effectiveness improved when a 30% reduction in the price of biologic agents was assumed (health system: CHF 134,502 per QALY; societal: intervention dominant) and when only the subgroup of patients who progressed to biologic treatments were evaluated (intervention dominant).

CONCLUSIONS

: Early compared to late/no biologic use was not cost-effective considering a threshold of CHF 100,000 per QALY. However, early identification and treatment of patients more likely to need biologic treatment and future drug price reductions might improve the cost-effectiveness of early biologic use.