Cost-effectiveness of biological treatment sequences for fistulising Crohn’s disease across Europe

Petra Baji, László Gulácsi, Valentin Brodszky, Zsuzsanna Végh, Silvio Danese, Peter M. Irving, Laurent Peyrin-Biroulet, Stefan Schreiber, Fanni Rencz, Péter L. Lakatos, Márta Péntek

Research output: Contribution to journalArticlepeer-review


Background: In clinical practice, treatment sequences of biologicals are applied for active fistulising Crohn’s disease, however underlying health economic analyses are lacking. Objective: The purpose of this study was to analyse the cost-effectiveness of different biological sequences including infliximab, biosimilar-infliximab, adalimumab and vedolizumab in nine European countries. Methods: A Markov model was developed to compare treatment sequences of one, two and three biologicals from the payer’s perspective on a five-year time horizon. Data on effectiveness and health state utilities were obtained from the literature. Country-specific costs were considered. Calculations were performed with both official list prices and estimated real prices of biologicals. Results: Biosimilar-infliximab is the most cost-effective treatment against standard care across the countries (with list prices: €34684–€72551/quality adjusted life year; with estimated real prices: €24364–€56086/quality adjusted life year). The most cost-effective two-agent sequence, except for Germany, is the biosimilar-infliximab–adalimumab therapy compared with single biosimilar-infliximab (with list prices: €58533–€133831/quality adjusted life year; with estimated prices: €45513–€105875/quality adjusted life year). The cost-effectiveness of the biosimilar-infliximab–adalimumab–vedolizumab three-agent sequence compared wit biosimilar-infliximab –adalimumab is €87214–€152901/quality adjusted life year. Conclusions: The suggested first-choice biological treatment is biosimilar-infliximab. In case of treatment failure, switching to adalimumab then to vedolizumab provides meaningful additional health gains but at increased costs. Inter-country differences in cost-effectiveness are remarkable due to significant differences in costs.

Original languageEnglish
Pages (from-to)310-321
Number of pages12
JournalUnited European Gastroenterology Journal
Issue number2
Publication statusPublished - Mar 1 2018


  • adalimumab
  • biosimilar
  • biosimilar-infliximab
  • Cost-effectiveness
  • fistulising Crohn’s disease
  • infliximab
  • vedolizumab

ASJC Scopus subject areas

  • Oncology
  • Gastroenterology

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