Evaluating the cost-effectiveness of early compared to late or no biologic treatment to manage Crohn's disease using real world data.

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 [CHF384607; 16.84 QALYs] compared with the comparator [CHF340800; 16.75 QALYs] strategy, resulting in high ICERs [health system: CHF887450 per QALY; societal: CHF449130 per QALY]. In probabilistic sensitivity analysis, assuming a threshold of CHF100000 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: CHF134502 per QALY; societal: intervention dominant]. Conclusions: Early biologic use was not cost-effective, considering a threshold of CHF100000 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.