OBJECTIVES: The impact of Crohn’s disease (CD) treatments and adverse events (AEs) has been previously researched and reported. However, less is known about their impact on health-related quality of life (HRQL) specifically for use in economic evaluations. The aim of this study was to elicit utility values for AEs related to biologic treatment and surgical complications for CD in the UK.

METHODS: Health state selection and wording were informed by literature review and interviews with CD patients (N=6) and gastroenterologists (N=3). Draft health states were validated in cognitive debrief interviews with other CD patients (N=4) and gastroenterologists (N=2). Treatment AEs were described with moderate-severe CD (baseline state) and included hypersensitivity, injection site reactions, serious infection, lymphoma, and tuberculosis. Surgical complications were described with bowel surgery (baseline state) and included anastomotic leak, wound infection, prolonged ileus obstruction, and intra-abdominal abscess. The final health states (n = 11) were piloted to check UK general public understanding. For health state valuation, UK general public participants (n=100) completed background questions, EQ-5D, visual analogue scale and time trade-off (TTO) with lead time method for states worse than dead.

RESULTS: The mean TTO value for baseline states ‘moderate to severe CD’ and ‘bowel surgery’ were 0.70 (SD=0.28) and 0.69 (SD=0.28). Participants rated moderate to severe CD+lymphoma as the worst state (0.44), then tuberculosis (0.47) and bowel surgery+anastomotic leak (0.48). Values of other states ranged from 0.76 (hypersensitivity) to 0.56 (intra-abdominal abscess). Overall, decline in utility was largest moving from ‘moderate to severe CD’ baseline state to also experiencing lymphoma (-0.26).

CONCLUSIONS: This study provides novel utility estimates for health states not previously assessed in the context of CD, or at all. As biologic treatments help CD patients avoid future bowel surgery it has become important to incorporate surgical complications in assessment of benefit.