{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:51:05Z","timestamp":1793321465767,"version":"4.5.0"},"reference-count":49,"publisher":"Oxford University Press (OUP)","issue":"9","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":51,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,9,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The PROFILE trial demonstrated that \u201ctop-down\u201d therapy in Crohn\u2019s disease, with combination infliximab and immunomodulator from diagnosis, had superior efficacy and safety over 1 year compared to conventional \u201caccelerated step-up\u201d management. The current study aimed to evaluate the cost-effectiveness of these alternative treatment strategies.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A Markov model was developed for the cost-effectiveness of \u201ctop-down\u201d compared to \u201caccelerated step-up\u201d 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The base-case cost-effectiveness analysis indicated that a \u201ctop-down\u201d strategy dominated over an \u201caccelerated step-up\u201d 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 \u00a31681 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 \u00a310\u2009059 per patient over 5\u2009years. Sensitivity analyses supported robustness of the results, showing \u201ctop-down\u201d to be the most cost-effective option in 98.7% of model simulations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\u201cTop-down\u201d treatment from diagnosis with anti-TNF results in lower healthcare resource use and better clinical outcomes in patients with Crohn\u2019s disease compared to an \u201caccelerated step-up\u201d strategy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ecco-jcc\/jjaf150","type":"journal-article","created":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T11:24:11Z","timestamp":1757330651000},"source":"Crossref","is-referenced-by-count":11,"title":["Anti-tumor necrosis factor treatment from diagnosis is more effective and less costly than conventional \u201cstep-up\u201d care for patients with active Crohn\u2019s disease: a cost-effectiveness 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