OBJECTIVES: This study focuses on identifying the most cost-effective biologic medication for Crohn's disease among Infliximab, Adalimumab, and Certolizumab, emphasizing economic viability in disease management.

METHODS: The research utilizes a Markov Model, developed in R using 'hesim' and 'heemod' packages, to simulate the health outcomes and costs for a cohort of 1,000 Crohn's disease patients over a five-year period, with monthly cycles. The model incorporates four health states: Complete Remission (CR), Remission (R), Non-remission (NR), and Surgery (S). A 3% annual discount rate is applied to both costs and quality-adjusted life years (QALYs), with sensitivity analyses for different discount rates. A threshold of $100,000/QALY is used to evaluate cost-effectiveness.

RESULTS: Infliximab demonstrates a total cost of $104,951,911 with 25,883.29 QALYs, while Adalimumab costs $110,042,863 for the same QALYs. Certolizumab shows higher costs ($128,268,045) with lower QALYs (24,931.42). ICER analysis finds Infliximab more cost-effective than both Adalimumab (-$19,304.53 per QALY) and Certolizumab (-$24,495.04 per QALY), with Adalimumab also more cost-effective than Certolizumab (-$19,146.68 per QALY).

CONCLUSIONS: Infliximab emerges as the most cost-effective option for Crohn's disease treatment among the three drugs, staying below the $100,000/QALY threshold and providing the highest QALYs at the lowest cost. The findings are significant for healthcare decision-makers, emphasizing the integration of economic assessments in clinical decisions, particularly in Crohn's disease management.