Personalised medicine for Crohns disease is a cost-effective strategy

Objective: To 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 & Methods: A 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. Results: Early personalised treatment with anti-TNF based combination therapy resulted in an incremental cost-effectiveness ratio (ICER) of GBP2,176 per quality-adjusted life year (QALY), with GBP717 incremental costs and 0.330 incremental QALYs, substantially below the NICE cost-effectiveness threshold of between GBP20,000 and GBP30,000 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. Conclusion: A 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. Keywords: Prognostic test, Biomarker, Personalised medicine, Cost-effectiveness, Crohns disease