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Cost-Consequences Analysis of Biologic Treatments for Moderate-to-Severe Crohn's Disease Using Real-World Transition
Thanaboon Chaemsupaphan1, Onuma Sattayalertyanyong1, Khachen Kongpakwattana2
1Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, 2, Wanglang Road, Bangkok Noi, Bangkok, 10700, Thailand.
Insights
Biologic therapies improve outcomes for Crohn's disease (CD) patients in Thailand. Infliximab is cost-effective for biologic-naïve patients, while conventional therapy is best for those previously treated with biologics.
Area of Science:
- Gastroenterology and Hepatology
- Health Economics
- Pharmacoeconomics
Background:
- Crohn's disease (CD) management requires sustained remission, often necessitating biologic therapy for moderate-to-severe cases.
- Evaluating the value of biologic agents in Thailand involves assessing cost consequences using real-world data.
- This study focuses on moderate-to-severe CD patients in Thailand.
Purpose of the Study:
- To evaluate the value of biologic agents in moderate-to-severe CD in Thailand.
- To assess the cost consequences of different treatment options using real-world transition probabilities and cost data.
- To compare conventional therapy, overall biologic therapies, infliximab, vedolizumab, and ustekinumab.
Main Methods:
- A decision tree and Markov model were adapted to estimate 2-year health outcomes and costs.
- Real-world data from Siriraj Hospital, Thailand, were used for transition probabilities and costs.
- Efficacy and safety data were sourced from published literature; uncertainty was assessed via sensitivity analyses.
Main Results:
- Biologics showed superior outcomes to conventional therapy, with higher remission rates and reduced healthcare resource utilization (hospitalization, surgeries).
- Infliximab was the most effective and cost-saving agent for biologic-naïve patients, saving 171,213 Thai baht.
- Conventional therapy was most cost-effective for biologic-exposed patients.
Conclusions:
- Biologic therapy improves outcomes and reduces healthcare use in moderate-to-severe CD.
- Infliximab is the most effective and cost-saving option for biologic-naïve patients in Thailand.
- Conventional therapy remains the most cost-effective choice for biologic-exposed patients, guiding treatment decisions.
Background And Objectives:
The treatment goal for patients with Crohn's disease (CD) is sustained clinical, biochemical, and endoscopic remission, with biologic therapy often necessary in moderate-to-severe cases. This study aimed to evaluate the value of biologic agents in moderate-to-severe CD in Thailand by assessing cost consequences using real-world transition probabilities and cost data.
Methods:
A published decision tree combined with a Markov model was adapted to estimate 2-year health outcomes, healthcare resource utilization, and cost implications of treatment options (conventional therapy, overall biologic therapies, infliximab, vedolizumab, and ustekinumab) for moderate-to-severe CD. The base-case analysis used a 2-year time horizon. Key input parameters, including transition probabilities and costs, were obtained from real-world data at Siriraj Hospital, a tertiary hospital in Thailand, while efficacy and safety data were sourced from relevant published literature. Uncertainty was assessed through scenario analyses and one-way sensitivity analyses varying input parameters across plausible ranges.
Results:
Overall, biologics demonstrated superior health outcomes compared to conventional therapy, with a higher remission rate (number needed to treat = 4) and reduced healthcare resource utilization, including lower hospitalization (absolute risk reduction; ARR = 135.3%) and fewer CD-related surgeries (ARR = 40.5%), although with a higher incidence of adverse drug reactions. Among biologic-naïve patients, infliximab was the most effective agent, with a cost-saving of 171,213 Thai baht compared to conventional therapy. Scenario and sensitivity analyses revealed consistent findings, with infliximab consistently dominating in biologic-naïve patients. Cost-effectiveness analyses demonstrated that infliximab dominated conventional therapy among biologic-naïve patients, while conventional therapy remained most cost-effective in biologic-exposed patients.
Conclusions:
Biologic therapy improved outcomes and reduced healthcare use compared with conventional therapy, but cost considerations remain crucial. Infliximab was most effective and cost-saving in biologic-naïve patients, whereas conventional therapy remained most cost effective in biologic-exposed patients. These real-world findings support treatment decisions for moderate-to-severe CD in Thailand.
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