Cost-utility of biological treatment sequences for luminal Crohn’s disease in Europe

Fanni Rencz, László Gulácsi, Márta Péntek, Krisztina B. Gecse, Axel Dignass, Jonas Halfvarson, Fernando Gomollón, Petra Baji, Laurent Peyrin-Biroulet, Peter L. Lakatos, Valentin Brodszky

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12 Citations (Scopus)


Background: This study aims to compare the cost-effectiveness of treatment sequences with available biologics, including adalimumab (ADA), biosimilar infliximab (bsIFX), originator infliximab (IFX) and vedolizumab (VEDO) for luminal Crohn’s disease in nine European countries. Methods: A Markov-model was constructed to simulate five-year medical costs and quality-adjusted life years (QALYs). Data on clinical efficacy were obtained from randomised controlled trials. Country-specific unit costs, discount rates and a third-party payer perspective were applied. Results: The bsIFX versus conventional therapy resulted in the most favourable incremental cost-utility ratios (ICURs) ranging from €34,580 (Hungary) to €77,062/QALY (Sweden). Compared to bsIFX, the bsIFX-ADA sequence was more cost-effective than the bsIFX-VEDO sequence with ICURs varying between €70,277 (France) and €162,069/QALY (Germany). The ICURs of the bsIFX-ADA-VEDO sequence versus the bsIFX-ADA strategy were between €206,266 (The Netherlands) and €363,232/QALY (Spain). Conclusion: We are the first to compare cost-effectiveness of multiple biological sequences for luminal Crohn’s disease. Based on our findings, bsIFX can be recommended as a first-line treatment in patients unresponsive to conventional treatments. While biological sequences only slightly differ in their associated health gains, their costs vary greatly. The bsIFX-ADA-VEDO seems to be the most cost-effective sequence of the available biologics across Europe.

Original languageEnglish
Pages (from-to)597-606
Number of pages10
JournalExpert Review of Pharmacoeconomics and Outcomes Research
Issue number6
Publication statusPublished - Nov 2 2017


  • Adalimumab
  • Crohn’s disease
  • biosimilar infliximab
  • cost-effectiveness
  • inflammatory bowel diseases
  • infliximab
  • vedolizumab

ASJC Scopus subject areas

  • Health Policy
  • Pharmacology (medical)

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    Rencz, F., Gulácsi, L., Péntek, M., Gecse, K. B., Dignass, A., Halfvarson, J., Gomollón, F., Baji, P., Peyrin-Biroulet, L., Lakatos, P. L., & Brodszky, V. (2017). Cost-utility of biological treatment sequences for luminal Crohn’s disease in Europe. Expert Review of Pharmacoeconomics and Outcomes Research, 17(6), 597-606.