Evaluating the Cost-Effectiveness of Early Compared with Late or No Biologic Treatment to Manage Crohn's Disease using Real-World Data

J Crohns Colitis. 2020 May 21;14(4):490-500. doi: 10.1093/ecco-jcc/jjz169.


Background and aims: We evaluated the cost-effectiveness of early [≤2 years after diagnosis] compared with late or no biologic initiation [starting biologics >2 years after diagnosis or no biologic use] for adults with Crohn's disease 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 were estimated using real-world data. Propensity score matching was used to ensure comparability between patients in the early [intervention] and late/no [comparator] biologic initiation strategies. The incremental cost-effectiveness ratio [ICER] per quality-adjusted life year [QALY] gained is reported in Swiss francs [CHF]. Sensitivity and scenario analyses were performed.

Results: Total costs and QALYs were higher for the intervention [CHF384 607; 16.84 QALYs] compared with the comparator [CHF340 800; 16.75 QALYs] strategy, resulting in high ICERs [health system: CHF887 450 per QALY; societal: CHF449 130 per QALY]. In probabilistic sensitivity analysis, assuming a threshold of CHF100 000 per QALY, the probability that the intervention strategy was cost-effective was 0.1 and 0.25 from the health system and societal perspectives, respectively. In addition, ICERs improved when we assumed a 30% reduction in biologic prices [health system: CHF134 502 per QALY; societal: intervention dominant].

Conclusions: Early biologic use was not cost-effective, considering a threshold of CHF100 000 per QALY compared with late/no biologic use. However, early identification of patients likely to need biologics and future drug price reductions through increased availability of biosimilars may improve the cost-effectiveness of an early treatment approach.

Keywords: Crohn’s disease; arly biologic initiation; cost-effectiveness.

MeSH terms

  • Adult
  • Biological Products* / economics
  • Biological Products* / therapeutic use
  • Biosimilar Pharmaceuticals / economics
  • Biosimilar Pharmaceuticals / pharmacology
  • Cost-Benefit Analysis
  • Crohn Disease* / diagnosis
  • Crohn Disease* / economics
  • Crohn Disease* / psychology
  • Crohn Disease* / therapy
  • Drug Costs
  • Female
  • Humans
  • Male
  • Needs Assessment
  • Quality of Life*
  • Quality-Adjusted Life Years
  • Switzerland
  • Time-to-Treatment* / economics
  • Time-to-Treatment* / statistics & numerical data


  • Biological Products
  • Biosimilar Pharmaceuticals