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A Systematic Review of Economic Studies on Biological Agents Used to Treat Crohn’s Disease

Tang, Derek H. MS*; Harrington, Amanda R. MS*; Lee, Jeannie K. PharmD, BCPS, CGP; Lin, Mark MD; Armstrong, Edward P. PharmD

doi: 10.1097/MIB.0b013e3182916046
Clinical Review Articles

Background: Identifying clinical scenarios that maximize the cost-effectiveness of biological treatments can lead to optimized health care cost-saving and clinical effectiveness from a society’s perspective.

Methods: Published articles between January 1995 and June 2012 were searched in PubMed, EMBASE, ABI/INFORM, Tuft’s Cost-Effectiveness Analysis Registry Database, Cochrane National Health Service Economic Evaluation Database, International Pharmaceutical Abstracts, Web of Science, and Google Scholar. Studies of interest included the following: (1) cost studies, (2) economic evaluations, or (3) narrative or systematic reviews related to economic evaluations of biological treatments for moderate-to-severe Crohn’s disease (CD). The primary outcomes of interest included costs associated with biological treatments and cost-effectiveness measures, including incremental cost-effectiveness ratios. A threshold of $100,000/quality-adjusted life year (£60,000/quality-adjusted life year) gained was used for treatment cost-effectiveness.

Results: Thirty-eight studies were identified, including 15 economic evaluations and 23 cost studies or reviews of economic evaluations. Economic evaluations found that infliximab and adalimumab were more cost-effective than standard therapy for luminal CD when provided as an induction therapy followed by episodic therapy over 5 or more years. The cost-effectiveness of infliximab and adalimumab versus standard therapy for luminal CD was less certain when used as 1-year maintenance treatment with or without previous induction therapy. Cost studies revealed that infliximab therapy reduced health care resource utilization and cost. Older reviews were inconclusive about the cost-effectiveness of biological treatments used for CD.

Conclusions: Current evidence suggests that biological treatments may be cost-effective for CD under certain clinical scenarios. Future studies evaluating all biological treatments are needed to compare their respective benefits and costs.

Article first published online 20 June 2013

*Department of Pharmaceutical Sciences and

Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona; and

Division of Gastroenterology, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona.

Reprints: Derek H. Tang, MS, College of Pharmacy, 1295 N Martin Avenue, Tucson, AZ 85721-0202 (e-mail:

D. H. Tang is supported by the predoctoral fellowship from the American Foundation for Pharmaceutical Education.

The authors have no conflicts of interest to disclose.

Received September 18, 2012

Accepted March 3, 2013

© Crohn's & Colitis Foundation of America, Inc.
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