A systematic review of economic studies on biological agents used to treat Crohn's disease

Derek H. Tang, Amanda R. Harrington, Jeannie K. Lee, Mark Lin, Edward P. Armstrong

Research output: Contribution to journalReview articlepeer-review

29 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)2673-2694
Number of pages22
JournalInflammatory bowel diseases
Issue number12
StatePublished - Nov 2013


  • Biologics
  • Cost
  • Cost-effective
  • Crohn's disease
  • Systematic review

ASJC Scopus subject areas

  • Immunology and Allergy
  • Gastroenterology


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