Personalised medicine for Crohns disease is a cost-effective strategy

ObjectiveTo evaluate the cost-effectiveness of a personalised medicine strategy for Crohns 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 Crohns 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 {pound}2,176 per quality-adjusted life year (QALY), with {pound}717 incremental costs and 0.330 incremental QALYs, substantially below the NICE cost-effectiveness threshold of between {pound}20,000 and {pound}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 models conclusion. ConclusionA personalised medicine strategy using anti-TNF therapy at diagnosis in Crohns 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 SUMMARYO_ST_ABSEstablished KnowledgeC_ST_ABSO_LICurrently 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 UK C_LIO_LIIt therefore remains unclear which patients with Crohns disease should be treated with early anti-TNF based therapy as part of a top-down regimen. C_LIO_LIAs a consequence, the majority of IBD patients in the UK are currently treated with an accelerated step-up approach C_LI Significant new findingsO_LIWe show here that the use of biomarkers at diagnosis to guide personalised use of such treatment is a cost-effective approach for treatment of Crohns disease. C_LIO_LIUse of a prognostic test to deliver personalised medicine for Crohns disease results in positive QALY of 0.330 C_LIO_LIThe approach is cost effective with an incremental cost of {pound}717 and an ICER of 2,176 C_LIO_LIThe models conclusions were unaffected by a wide range of sensitivity analyses C_LI