Cost-Consequences Analysis of Biologic Treatments for Moderate-to-Severe Crohn's Disease Using Real-World Transition Probability and Cost Data in Thailand.

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.