Evaluating the Cost-Effectiveness of Early Compared with Late or No Biologic Treatment to Manage Crohn’s Disease using Real-World Data
Authors: Pillai Nadia , Lupatsch Judith E , Dusheiko Mark , Schwenkglenks Matthias , Maillard Michel , Sutherland C Simone , Pittet Valérie E H ,   Swiss IBD Cohort Study group, Anderegg Claudia , Bauerfeind Peter , Beglinger Christoph , Begré Stefan , Belli Dominique , Bengoa José M , Biedermann Luc , Bigler Beat , Binek Janek , Blattmann Mirjam , Boehm Stephan , Borovicka Jan , Braegger Christian P , Brunner Nora , Bühr Patrick , Burnand Bernard , Burri Emanuel , Buyse Sophie , Cremer Matthias , Criblez Dominique H , de Saussure Philippe , Degen Lukas , Delarive Joakim , Doerig Christopher , Dora Barbara , Dorta Gian , Egger Mara , Ehmann Tobias , El-Wafa Ali , Engelmann Matthias , Ezri Jessica , Felley Christian , Fliegner Markus , Fournier Nicolas , Fraga Montserrat , Frei Pascal , Frei Remus , Fried Michael , Froehlich Florian , Funk Christian , Furlano Raoul Ivano , Gallot-Lavallée Suzanne , Geyer Martin , Girardin Marc , Golay Delphine , Grandinetti Tanja , Gysi Beat , Haack Horst , Haarer Johannes , Helbling Beat , Hengstler Peter , Herzog Denise , Hess Cyrill , Heyland Klaas , Hinterleitner Thomas , Hiroz Philippe , Hirschi Claudia , Hruz Petr , Iwata Rika , Jost Res , Juillerat Pascal , Keller Céline , Knellwolf Christina , Knoblauch Christoph , Köhler Henrik , Koller Rebekka , Krieger-Grübel Claudia , Kullak-Ublick Gerd , Künzler Patrizia , Landolt Markus , Lange Rupprecht , Lehmann Frank Serge , Macpherson Andrew , Maerten Philippe , Maillard Michel H , Manser Christine , Manz Michael , Marbet Urs , Marx George , Matter Christoph , Meier Rémy , Mendanova Martina , Michetti Pierre , Misselwitz Benjamin , Morell Bernhard , Mosler Patrick , Mottet Christian , Müller Christoph , Müller Pascal , Müllhaupt Beat , Münger-Beyeler Claudia , Musso Leilla , Nagy Andreas , Neagu Michaela , Nichita Cristina , Niess Jan , Nydegger Andreas , Obialo Nicole , Oneta Carl , Oropesa Cassandra , Peter Ueli , Peternac Daniel , Petit Laetitia Marie , Piccoli-Gfeller Franziska , Pilz Julia Beatrice , Pittet Valérie , Raschle Nadia , Rentsch Ronald , Restellini Sophie , Richterich Jean-Pierre , Rihs Sylvia , Ritz Marc Alain , Roduit Jocelyn , Rogler Daniela , Rogler Gerhard , Rossel Jean-Benoît , Rueger Vanessa , Saner Gaby , Sauter Bernhard , Sawatzki Mikael , Schäppi Michela , Scharl Michael , Scharl Sylvie , Schelling Martin , Schibli Susanne , Schlauri Hugo , Uebelhart Sybille Schmid , Schnegg Jean-François , Schoepfer Alain , Seibold Frank , Seirafi Mariam , Semadeni Gian-Marco , Semela David , Senning Arne , Sidler Marc , Sokollik Christiane , Spalinger Johannes , Spangenberger Holger , Stadler Philippe , Steuerwald Michael , Straumann Alex , Straumann-Funk Bigna , Sulz Michael , Suter Alexandra , Thorens Joël , Tiedemann Sarah , Tutuian Radu , Vavricka Stephan , Viani Francesco , Vögtlin Jürg , Von Känel Roland , Vonlaufen Alain , Vouillamoz Dominique , Vulliamy Rachel , Wermuth Jürg , Werner Helene , Wiesel Paul , Wiest Reiner , Wylie Tina , Zeitz Jonas , Zimmermann Dorothee 
Published: October 2019

Background and Aims

We evaluated the cost-effectiveness of early [≤2 years after diagnosis] compared with late or no biologic initiation [starting biologics &gt;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.