OBJECTIVES: The advent of biologic drugs for Crohn’s disease (CD) has represented a great advance for the treatment of this highly disabling disease, whose prevalence has been rising in Brazil in a fast pace since 1990. However, surgery is still frequent and generates high costs for payers and disability for patients. The goal of this study is to estimate and compare the surgery related costs averted by the use four biologic drugs for the treatment of CD from a large Brazilian private payer perspective.

METHODS: A Markov model was built in Microsoft Excel to simulate the journey of a 100-patient cohort and to calculate the number of surgeries undergone by patients using ustekinumab (UST), adalimumab (ADA), certolizumab pegol (CZP), vedolizumab (VDZ) and synthetic therapy (azathioprine and prednisolone). The model was composed by the following health states: remission, response, non-response and death. Death probabilities were obtained in the Brazilian life tables and multipliers were applied depending on the health state. Short and long terms remission and response probabilities were described in a network meta-analysis published elsewhere. Surgery probability was obtained through literature search and was 43,8% after 16 weeks with no response to drug treatment. Surgery cost were provided by Unimed Rio Preto, a private payer in the state of São Paulo and the obtained mean cost was BRL 7,079.67 (excluding outliers, which ranged from BRL 4k to 100k).

RESULTS: In a three-year time horizon, the total surgery-related costs for the cohort using synthetic drugs were BRL 356,578 and for biologics, the costs were: BRL 260,340, BRL 285,562 and BRL 290,246 and BRL 319,628 for UST, ADA, CZP and VDZ respectively.

CONCLUSIONS: Surgery-related costs for UST-treated cohort are BRL 25,222 to 59,288 lower than other biologic drugs.