Published online Feb 28, 2026. doi: 10.3748/wjg.v32.i8.115291
Revised: December 23, 2025
Accepted: February 3, 2026
Published online: February 28, 2026
Processing time: 121 Days and 5.2 Hours
Biologics are the preferred treatment for patients with moderate to severe Crohn’s disease (CD). Four biologics included in China’s National Reimbursement Drug List are available for CD treatment. Due to loss of response, patients need swit
To assess the cost-effectiveness of sequential treatment strategies with National Reimbursement Drug List-included biologics for moderate to severe CD in China.
From a healthcare system perspective, a Markov model was constructed to evaluate the cost-effectiveness of four biologics [infliximab, adalimumab (ADA), ustekinumab (UST), and vedolizumab] applied in different treatment sequences for moderate to severe CD patients. Using one times the GDP per capita ($13444.68, 2024) in China as the willingness-to-pay threshold, the absolute net monetary benefit (NMB) and incremental cost-effectiveness ratio (ICER) were calculated. Both costs and utilities were discounted at an annual rate of 5%. Sensitivity analyses were conducted on key parameters.
With $13444.68 as willingness-to-pay, among the 17 treatment sequences evaluated for biologic-naïve patients, sequence 3 (ADA-UST) yielded the highest absolute NMB of $35850.93. Compared with sequence 1 (vedolizumab-UST), sequence 3 had the most favorable ICER of $2285.38/quality-adjusted life year. For biologic-exposed patients, sequence 3 still demonstrated the optimal NMB and ICER results.
Adding biologic treatment lines provides greater health benefits for patients with moderate to severe CD. Among the various sequential strategies, the treatment sequence combining ADA and UST is more likely to be the optimal cost-effective option in China.
Core Tip: Using a Markov model, this study evaluated the cost-effectiveness of 17 sequential biologic strategies for moderate-to-severe Crohn’s disease in China. Under a willingness-to-pay threshold of one time the 2024 GDP per capita, the findings suggest that while additional lines of biologic therapy improve health outcomes, they concurrently increase costs. The sequence initiating with adalimumab and followed by ustekinumab emerged as the most cost-effective option, yielding the highest net monetary benefit and a favorable incremental cost-effectiveness ratio for both biologic-naïve and biologic-exposed patients.