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

We evaluated the cost-effectiveness of early (≤2 years after diagnosis) compared to late or no biologic initiation (starting biologics >2 years after diagnosis or no biologic use) for adults with Crohn's disease in Switzerland.; 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.; Total costs and QALYs were higher for the intervention (CHF384,607; 16.84 QALYs) compared to comparator (CHF340,800; 16.75 QALYs) strategy, resulting in high ICERs (health system: CHF887,450 per QALY; societal: CHF449,130 per QALY). Assuming a threshold of CHF100,000 per QALY, in probabilistic sensitivity analysis the intervention strategy had a 0.1 and 0.25 probability of being cost-effective 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).; Early biologic use was not cost-effective considering a threshold of CHF100,000 per QALY compared to 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.