Economic implications of biological therapies for Crohn's disease: review of infliximab.

Crohn's disease is a chronic, relapsing inflammatory bowel disease that may require extensive medical and surgical interventions. Traditional therapies include 5-aminosalicylates, corticosteroids, immunosuppressants (e.g. azathioprine, mercaptopurine), defined formula diets, antibacterials and surgery. Infliximab is an anticytokine therapy for Crohn's disease that targets tumour necrosis factor-alpha. Infusions of infliximab have been shown to be superior to placebo in the induction and maintenance of remission in moderately severe and/or fistulising Crohn's disease. This review briefly summarises the data for clinical effectiveness of infliximab and then considers the economic implications of its use. Available economic modelling exercises suggest that infliximab has a relatively high incremental cost per QALY compared with standard care. However, there are limitations to these theoretical data and there has been no direct assessment of cost effectiveness within a controlled trial. Effective alternative treatment options for moderate-to-severe Crohn's disease are relatively lacking. More data are needed relating to the long-term safety of infliximab and the extent to which this new biological therapy produces lasting clinical benefits.