TOPLINE:

Starting anti-TNF treatment at diagnosis is more cost-effective than accelerated step-up care for active Crohn’s disease, saving £1681 per patient over 5 years while improving clinical outcomes by reducing flares, hospital stays, and surgeries.

METHODOLOGY:

• Although management of Crohn’s disease traditionally involves gradually intensifying treatments, the PROFILE trial demonstrated that initiating top-down therapy with an anti-TNF agent plus an immunomodulator at diagnosis led to superior clinical outcomes than an accelerated step-up approach.
• In this health economic analysis, researchers used data from the PROFILE trial, which enrolled 386 adults with newly diagnosed active Crohn’s disease randomized to either a top-down strategy (anti-TNF drug [infliximab or adalimumab] plus an immunomodulator) or an accelerated step-up strategy beginning with conventional therapies and escalating to advanced treatments.
• A Markov model was developed to compare the cost-effectiveness of both approaches. All patients were modelled from treatment initiation in the active disease state.
• Outcomes included healthcare costs (drug acquisition/administration, disease management, hospitalization, and surgery) and health benefits measured in quality-adjusted life years (QALYs) over a 5-year horizon.

TAKEAWAY:

• Per patient, the top-down strategy yielded an incremental gain of 0.17 QALYs over 5 years and saved £1681 compared with the accelerated step-up care.
• Patients receiving early anti-TNF therapy experienced fewer flares (0.6 vs 5.0 per patient), shorter hospital stays (2.0 vs 4.7 days), and 3.9 times fewer surgeries than those in the accelerated step-up group.
• Similar clinical benefits were observed with subcutaneous anti-TNF options, with adalimumab providing the greatest cost savings at £10,059 per patient over 5 years.
• Sensitivity analyses confirmed that the top-down approach was the most cost-effective option in 98.7% of model simulations.

IN PRACTICE:

“Given these findings, initiation of early effective ‘top-down’ treatment should be considered the standard of care for patients newly diagnosed with active Crohn’s disease,” the authors wrote.

SOURCE:

This study was led by Nurulamin M. Noor, PhD, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England. It was published online in the Journal of Crohn’s and Colitis.

LIMITATIONS:

The model is sensitive to assumptions about anti-TNF therapy discontinuation rates beyond trial follow-up. Contract pricing for medications was only evaluated from trial sites, though these encompassed a broad range of hospitals and regions across the UK. Outpatient visits only included extra ad hoc trial-recorded encounters, potentially underestimating real-world contact frequency.

DISCLOSURES:

This study was funded by the Wellcome Trust. Some authors reported receiving educational/travel grants, speaker fees, industry research support from, and other ties with various pharmaceutical companies.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.