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

Abstract

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.