BACKGROUND: Moderate-to-severe Crohn’s disease (CD) is a chronic, progressive disease characterized by inflammation of the lining of the gut. Treatment options include targeted biological therapies such as tumor necrosis factor (TNF)-alpha inhibitors (e.g. infliximab, adalimumab) and anti-integrin and anti-IL-23 treatments (vedolizumab, ustekinumab). With increasing treatment options, understanding economic evaluations of different therapies is crucial to inform clinical practice. The aim of this systematic literature review (SLR) was to summarize published economic evaluation models of biologic treatments for CD in Europe.
METHODS: An SLR was conducted to identify studies (economic analyses, systematic literature reviews, meta-analyses, and health technology assessments [HTAs]) of biological therapies in patients with moderate-to-severe CD, published in English from 1 January 2012 to 22 June 2018. Literature searches were performed in MEDLINE, Embase, EconLit, and the Cochrane library databases. Conference abstracts from the past 2 years were reviewed, along with key HTA websites. Bibliographic lists of relevant SLRs were also interrogated. Study selection was guided by prespecified inclusion and exclusion criteria.
RESULTS: Thirteen economic analyses were identified, of which 10 compared biological treatment with biological and/or conventional therapy, 1 compared biological treatment with surgery and 2 focused on clinical management of CD. Biologics considered included infliximab, infliximab biosimilar, adalimumab, vedolizumab, and ustekinumab. Ten analyses were performed from a health systems perspective while three studies presented data from a societal perspective. Economic models utilized in the studies included decision tree models, Markov models, or hybrid decision tree–Markov approaches. The models were built around key endpoints of response and remission. Efficacy of first- and second-generation biologics when compared with one another was estimated primarily using network meta-analyses. The time horizon of analyses ranged from 48 weeks to lifetime. Key health states considered include remission, mild disease, moderate/severe disease, surgery, and death. The value of second-generation biologics (vedolizumab and ustekinumab) was examined separately in anti-TNF naïve and anti-TNF failure patient populations in five studies. These biologics were more cost effective in the anti-TNF failure population than the anti-TNF naïve group. Sequencing of biologics was considered in two analyses.
CONCLUSION: Several modelling structures have been used to model CD using various time horizons. As treatment options for CD increase in Europe, economic evaluations comparing biologics to each other has become increasingly important. In addition, as more treatments are approved, the impact of sequencing of biologics may need to be considered and may in turn dictate analyses of longer time horizons.
