Personalised medicine for Crohn’s disease is a cost-effective strategy

Abstract

ABSTRACTObjectiveTo evaluate the cost-effectiveness of a personalised medicine strategy for Crohn’s disease in the UK, using early targeted top-down therapy compared to standard of care.Materials & MethodsA decision tree leading into a Markov state-transition model was constructed, allowing comparison of two treatment approaches: 1) standard of care therapy following established UK clinical guidelines (‘step-up’ treatment) and 2) a personalised medicine strategy in which patients identified as high-risk of subsequent relapse using a prognostic biomarker receive ‘top-down’ anti-TNF treatment at diagnosis. The model facilitated comparison of both costs and Quality Adjusted Life Years (QALYs) in a hypothetical cohort of newly diagnosed Crohn’s disease patients with sensitivity analyses undertaken to model the impact of key assumptions.ResultsEarly personalised treatment with anti-TNF based combination therapy resulted in an incremental cost-effectiveness ratio (ICER) of £2,176 per quality-adjusted life year (QALY), with £717 incremental costs and 0.330 incremental QALYs, substantially below the NICE cost-effectiveness threshold of between £20,000 and £30,000 per QALY. Additional costs relating to earlier biologic use were offset by incremental QALYS and reductions in costs driven by fewer disease flares and hospitalisations. Sensitivity analysis across a wide range of parameter assumptions did not impact on the model’s conclusion.ConclusionA personalised medicine strategy using anti-TNF therapy at diagnosis in Crohn’s disease to patients at high risk of subsequent relapse is highly likely to be a cost-effective use of resources in the UK National Health Service.KEY SUMMARYEstablished KnowledgeCurrently there are no validated prognostic test that can stratify IBD patients based on long term outcomes at the point of diagnosis used routinely in the UKIt therefore remains unclear which patients with Crohn’s disease should be treated with early anti-TNF based therapy as part of a ‘top-down’ regimen.As a consequence, the majority of IBD patients in the UK are currently treated with an accelerated step-up approachSignificant new findingsWe show here that the use of biomarkers at diagnosis to guide personalised use of such treatment is a cost-effective approach for treatment of Crohn’s disease.Use of a prognostic test to deliver personalised medicine for Crohn’s disease results in positive QALY of 0.330The approach is cost effective with an incremental cost of £717 and an ICER of 2,176The model’s conclusions were unaffected by a wide range of sensitivity analyses