Cost-effectiveness of different strategies with biologics for the treatment of moderate to severe Crohn’s disease in China

Table 1 Summary of efficacy and safety of biologics for treating moderate to severe Crohn’s disease

	Biological-naïve		Biological-exposed		Serious adverse event (%)
	Response rate (%)	Remission rate (%)	Response rate (%)	Remission rate (%)
Induction phase
IFX	86.12	43.27	30.68	12.28	6.61
ADA	41.26	33.63	35.38	28.29	4.46
UST	44.04	30.67	38.18	17.96	5.28
VDZ	32.67	25.09	30.68	12.28	6.87
PBO	22.00	11.00	20.00	10.00	7.00
Maintenance phase
IFX	62.17	47.34	34.06	17.45	16.14
ADA	87.80	84.51	34.06	17.45	11.27
UST	89.84	84.90	69.90	49.76	13.16
VDZ	61.13	46.81	34.06	17.45	16.72
PBO	39.00	32.00	26.00	16.00	17.00

ADA: Adalimumab; IFX: Infliximab; PBO: Placebo; UST: Ustekinumab; VDZ: Vedolizumab.

Table 2 Model inputs of cohort characteristics, transition probability, costs, and utility

Parameters	Value	Ref.
Cohort characteristics
Age	30	Xu et al[5], 2023
Female (%)	46.65	Xu et al[5], 2023
Weight (kg)	60
Transition probability
Post-surgical remission	52.68%	Bouhnik et al[13], 2023
Post-surgical active disease	47.32%	Bouhnik et al[13], 2023
Recurrence after surgery	3.50%	Bouhnik et al[13], 2023
Death rate	Age-gender-specific death rate	Cai[20], 2012
Costs
Infliximab	$204.40/100 mg IV	Induction: 5 mg/kg, 0/2/6 weeks; maintenance: 5 mg/kg, every 8 weeks
Adalimumab	$144.71/40 mg SC	Induction: 160 mg 0 week, 80 mg 2 weeks; maintenance: 40 mg, every 2 weeks
Ustekinumab	$302.11/130 mg IV $958.59/90 mL SC	Induction: 390 mg; maintenance: 90 mg, every 12 weeks
Vedolizumab	$699.27/300 mg IV	Induction: 300 mg, 0/2/6 weeks; maintenance: 300 mg, every 8 weeks
SAE	$1507.46/cycle	Zhou et al[11], 2021
Surgery	$9849.27/cycle	Average colectomy cost of China Healthcare Security Diagnosis Related Group 2.0
Conventional therapy (induction)	$125.42/cycle	Inflammatory Bowel Disease Group[2], 2024
Conventional therapy (maintenance)	$103.79/cycle	Inflammatory Bowel Disease Group[2], 2024
Utility
Active disease	0.40	Bouhnik et al[13], 2023; Lindsay et al[18], 2008
Clinical remission	0.83	Bouhnik et al[13], 2023; Lindsay et al[18], 2008
Clinical response	0.55	Bouhnik et al[13], 2023; Lindsay et al[18], 2008
Surgery	0.40	Bouhnik et al[13], 2023
Post-surgical remission	0.67	Bouhnik et al[13], 2023; Lindsay et al[18], 2008
Post-surgical active disease	0.40	Bouhnik et al[13], 2023
Disutility of SAE	0.07	Worbes-Cerezo et al[19], 2019

IV: Intravenous injection; SAE: Serious adverse event; SC: Subcutaneous injection.

Table 3 Summary of net monetary benefit and incremental cost-effectiveness ratio results in base case analysis comparing different biologic sequences for biologic-naïve Crohn’s disease patients

Sequence	Costs ($)	QALY	Net monetary benefit ($)	Incremental costs ($)	Incremental QALYs	Incremental cost-effectiveness ratio ($/QALY)1
Sequence 1: VDZ-UST	22392.37	3.967	30948.45	-	-	-
Sequence 2: IFX-ADA	23555.90	4.117	31790.65	1163.52	0.149	7799.27
Sequence 3: ADA-UST	23396.38	4.407	35850.93	1004.01	0.439	2285.38
Sequence 4: IFX-UST	24697.41	4.272	32741.92	2305.04	0.305	7561.41
Sequence 5: ADA-VDZ	23127.51	4.248	33981.33	735.13	0.280	2623.04
Sequence 6: UST-VDZ	24271.51	4.335	34005.35	1879.14	0.367	5118.36
Sequence 7: IFX-VDZ	24446.82	4.101	30686.86	2054.45	0.133	15406.35
Sequence 8: IFX-UST-VDZ	27191.67	4.322	30920.52	4799.30	0.355	13523.37
Sequence 9: IFX-ADA-VDZ	26236.50	4.171	29844.52	3844.12	0.204	18861.04
Sequence 10: IFX-UST-ADA	26366.71	4.337	31936.78	3974.34	0.369	10767.13
Sequence 11: IFX-ADA-UST	26397.00	4.333	31856.02	4004.63	0.365	10960.66
Sequence 12: IFX-VDZ-UST	27305.37	4.318	30751.11	4913.00	0.351	14007.32
Sequence 13: ADA-UST-VDZ	25665.78	4.453	34207.27	3273.41	0.486	6737.35
Sequence 14: ADA-VDZ-UST	25762.83	4.450	34062.39	3370.46	0.482	6988.27
Sequence 15: UST-VDZ-ADA	25821.32	4.396	33277.94	3428.95	0.428	8005.84
Sequence 16: VDZ-ADA-UST	24281.88	4.037	29989.99	1889.51	0.069	27285.02
Sequence 17: VDZ-UST-ADA	24256.07	4.040	30061.27	1863.70	0.073	25659.35

¹Compared to sequence 1 (vedolizumab-ustekinumab).

ADA: Adalimumab; IFX: Infliximab; QALYs: Quality-adjusted life years; UST: Ustekinumab; VDZ: Vedolizumab.

Table 4 Summary of net monetary benefit and incremental cost-effectiveness ratio results comparing different biologic sequences for biologic-exposed Crohn’s disease patients

Sequence	Costs ($)	QALY	Net monetary benefit ($)	Incremental costs ($)	Incremental QALYs	Incremental cost-effectiveness ratio ($/QALY)1
Sequence 1: VDZ-UST	21375.37	3.848	30363.95	-	-	-
Sequence 3: ADA-UST	20813.64	3.865	31150.98	-561.73	0.017	-33520.57
Sequence 5: ADA-VDZ	20304.88	3.664	28962.46	-1070.49	-0.184	5822.22
Sequence 6: UST-VDZ	21899.71	3.852	29883.92	524.34	0.003	159090.08
Sequence 13: ADA-UST-VDZ	23620.33	3.924	29137.76	2244.97	0.076	29626.51
Sequence 14: ADA-VDZ-UST	23714.52	3.921	28995.66	2339.16	0.072	32392.94
Sequence 15: UST-VDZ-ADA	23814.60	3.927	28983.03	2439.23	0.079	30987.73
Sequence 16: VDZ-ADA-UST	23315.89	3.920	29393.93	1940.52	0.072	26882.61
Sequence 17: VDZ-UST-ADA	23291.21	3.924	29462.02	1915.84	0.075	25404.50

¹Compared to sequence 1 (vedolizumab-ustekinumab).

ADA: Adalimumab; QALYs: Quality-adjusted life years; UST: Ustekinumab; VDZ: Vedolizumab.