ArticleJournal of Crohn's & colitis2025
Anti-tumor necrosis factor treatment from diagnosis is more effective and less costly than conventional "step-up" care for patients with active Crohn's disease: a cost-effectiveness analysis from the PROFILE trial.
Article in Journal of Crohn's & colitis, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
4 citing papers in PubMed.
- Biosimilars: A Virtuous Cycle of Sustainability and Innovation.BioDrugs : clinical immunotherapeutics, biopharmaceuticals and gene therapy · 2026Review
- Addressing real-world data gaps: estimating the uk population cost of crohn's disease and ulcerative colitis using a flexible cost-of-illness model informed by the optimal patient journey and IBDUK patient survey 2023.BMC health services research · 2026Article
- Early Intervention in Crohn's Disease.Gastroenterology & hepatology · 2026Article
- Redefining Early Intervention and the Window of Opportunity in Crohn's Disease.Gastroenterology & hepatology · 2026Article
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
backgroundThe PROFILE trial demonstrated that "top-down" therapy in Crohn's disease, with combination infliximab and immunomodulator from diagnosis, had superior efficacy and safety over 1 year compared to conventional "accelerated step-up" management. The current study aimed to evaluate the cost-effectiveness of these alternative treatment strategies.
methodsA Markov model was developed for the cost-effectiveness of "top-down" compared to "accelerated step-up" treatment. Parameters were informed by individual patient data from PROFILE and published data. Use of anti-tumor necrosis factor (TNF) therapy was modeled, using real-world contract drug costs from 18 PROFILE sites. Key model outcomes included healthcare costs (drug acquisition, drug administration, disease management, hospitalization, and surgery) and health outcomes [quality-adjusted life years (QALYs) gained] measured over a 5-year time horizon.
resultsThe base-case cost-effectiveness analysis indicated that a "top-down" strategy dominated over an "accelerated step-up" approach. Initiating intravenous infliximab from diagnosis yielded an incremental gain of 0.17 QALYs per patient over a 5-year period, and was less costly, saving £1681 per patient over the same time frame. Similar clinical benefits were obtained when modeling for subcutaneous infliximab and adalimumab. The greatest cost savings were with adalimumab, totaling £10 059 per patient over 5 years. Sensitivity analyses supported robustness of the results, showing "top-down" to be the most cost-effective option in 98.7% of model simulations.
conclusions"Top-down" treatment from diagnosis with anti-TNF results in lower healthcare resource use and better clinical outcomes in patients with Crohn's disease compared to an "accelerated step-up" strategy.
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