title: A systematic review of economic studies on biological agents used to treat Crohn's disease.
abstract: BACKGROUND
  Identifying clinical scenarios that maximize the cost-effectiveness of biological treatments can lead to optimized health care cost-saving and clinical effectiveness from a society's perspective.
  
  
  METHODS
  Published articles between January 1995 and June 2012 were searched in PubMed, EMBASE, ABI/INFORM, Tuft's Cost-Effectiveness Analysis Registry Database, Cochrane National Health Service Economic Evaluation Database, International Pharmaceutical Abstracts, Web of Science, and Google Scholar. Studies of interest included the following: (1) cost studies, (2) economic evaluations, or (3) narrative or systematic reviews related to economic evaluations of biological treatments for moderate-to-severe Crohn's disease (CD). The primary outcomes of interest included costs associated with biological treatments and cost-effectiveness measures, including incremental cost-effectiveness ratios. A threshold of $100,000/quality-adjusted life year (£60,000/quality-adjusted life year) gained was used for treatment cost-effectiveness.
  
  
  RESULTS
  Thirty-eight studies were identified, including 15 economic evaluations and 23 cost studies or reviews of economic evaluations. Economic evaluations found that infliximab and adalimumab were more cost-effective than standard therapy for luminal CD when provided as an induction therapy followed by episodic therapy over 5 or more years. The cost-effectiveness of infliximab and adalimumab versus standard therapy for luminal CD was less certain when used as 1-year maintenance treatment with or without previous induction therapy. Cost studies revealed that infliximab therapy reduced health care resource utilization and cost. Older reviews were inconclusive about the cost-effectiveness of biological treatments used for CD.
  
  
  CONCLUSIONS
  Current evidence suggests that biological treatments may be cost-effective for CD under certain clinical scenarios. Future studies evaluating all biological treatments are needed to compare their respective benefits and costs.
authors.affiliation: *Department of Pharmaceutical Sciences and †Department of Pharmacy Practice and Science, University of Arizona College of Pharmacy, Tucson, Arizona; and ‡Division of Gastroenterology, Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona.
authors.forename: Derek H
authors.initials: DH
authors.lastname: Tang
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Harrington
authors.forename: Jeannie K
authors.initials: JK
authors.lastname: Lee
authors.forename: Mark
authors.initials: M
authors.lastname: Lin
authors.forename: Edward P
authors.initials: EP
authors.lastname: Armstrong
mesh_terms: D001685:Biological Factors / Q000191:economics* / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000235:genetics*; D003362:Cost-Benefit Analysis; D003424:Crohn Disease / Q000188:drug therapy / Q000191:economics*; D017048:Health Care Costs; D006801:Humans
chemical_list: D001685:Biological Factors