Cost-effectiveness of treatment and care of patients with gastrointestinal inflammatory diseases: a systematic review

AIMS: The aim of this study was to systematically review and descriptively synthesize published cost-effectiveness evidence for biologic versus non-biologic treatments as well as comparisons among different biologic therapies and treatment sequencing strategies, in inflammatory bowel disease, highlighting patterns and variability across disease types, treatment strategies, and study designs. MATERIALS AND METHODS: We conducted a systematic review following the PRISMA guidelines, searching the Web of Science and PubMed databases for studies published between 2013 and 2024. Studies comparing the cost-effectiveness of treatments for inflammatory bowel disease were included. RESULTS: Eighteen studies met the inclusion criteria, covering Crohn's disease and/or ulcerative colitis. Biologic therapies were generally associated with superior health outcomes compared with conventional treatments. Reported quality-adjusted life years (QALYs) ranged from 2.23 to 18.12 for biologic therapies and from 1.69 to 17.99 for non-biologic treatments. Although biologic therapies have higher costs, they are generally considered cost-effective. For Crohn's disease, infliximab was reported as a cost-effective biologic option, while findings for ulcerative colitis varied. Surgical intervention (colectomy) was identified as a cost-effective in selected clinical scenarios. CONCLUSION: Biologic therapies for inflammatory bowel disease are cost-effective, providing significant health benefits that offset higher costs. Substantial methodological heterogeneity and reliance on model-based economic evaluations limit direct comparability across studies. Future economic evaluations should focus on methodological consistency and transparency in assumptions to strengthen the interpretability of cost-effectiveness evidence.