BACKGROUND: Crohn’s disease (CD) is a multifactorial inflammatory disease leading to disabling life-altering symptoms and reduced quality of life. Exclusive enteral nutrition (EEN) is recommended as a first-line option to induce remission in mild-to-moderate active paediatric CD, followed by partial enteral nutrition (PEN) for maintenance. Modulen IBD is a specialised formula for the dietary management of CD in EEN and PEN.

OBJECTIVES: To estimate the incremental cost-effectiveness of the specialised formula (Modulen IBD, Nestlé Health Science) versus standard oral nutritional supplements (ONS) to induce and maintain remission of active, mild-to-moderate CD in paediatric patients from the perspective of the UK national health system.

METHODS: We developed a 1-year horizon Markov model with five health states (remission, mild-to-moderate, moderate-to-severe, surgery and death) and an 8-week cycle to compare the specialised formula vs standard ONS in EEN and PEN. Treatment effectiveness (clinical remission rates) and health state utilities (CHU9D) were sourced from the literature. Intervention costs and healthcare resources costs (in 2023 British pounds) were obtained from the British National Formulary and the National Tariff Payment System, respectively. Model design and validation of its structure were further developed with the inputs from clinical experts and payers. One-way sensitivity and scenario analyses assessed the robustness of findings.

RESULTS: The base case results showed that the specialised formula saves £746 with similar quality-adjusted life-years (QALYs) per patient over 1 year versus standard ONS. Based on current evidence we can estimate that in a cohort of 1,000 patients, 586 would achieve remission with the specialised formula versus 485 with standard ONS. The probabilistic sensitivity analysis showed that, at a £20,000/QALY willingness-to-pay threshold, the specialised formula was 83% more likely to be cost-effective versus standard ONS.

CONCLUSIONS: The present CEA shows that the specialized formula is superior to standard ONS, being less costly and more effective.