Cost-effectiveness analysis of guselkumab for Crohn’s disease in adults

Objective. Cost-effectiveness analysis of guselkumab therapy compared to no genetically engineered biological therapy in adults with moderate-to-severe Crohn’s disease in the Russian healthcare system with emphasis on the number of prevented surgical interventions, admissions and disability cases over 5-year and lifetime periods. Material and methods. A cohort Markov model with an 8-week cycle and health status parameters was developed: active course (Active), clinical response (Response), clinical remission (Remission), steroid-free clinical and endoscopic remission (Deep Remission), surgery (transient state), post-surgery state (post-surgery), and death. The analysis horizon was 5 years and lifelong (30 years). Clinical data on efficacy of guselkumab were obtained from pooled data of the GALAXI-2 and GALAXI-3 randomized clinical trials. Transition probabilities for subsequent years are based on real-world practice (M. Sanon, 2026) and data from the Russian registry of inflammatory bowel diseases. The analysis perspective is healthcare system and society of the Russian Federation. Results. Over a 5-year horizon per 100 patients, guselkumab provides direct medical resource savings of approximately 6.8 million rubles by preventing 41.1 surgical interventions, 3.5 million rubles by preventing 51.8 hospitalizations and 0.459 patient-years of disability-free life per a patient with indirect cost savings of approximately 713.000 rubles per a patient. Over a lifetime, 116.6 surgical interventions (11.6 million rubles) and 205.5 hospitalizations (7.6 million rubles) are prevented per 100 patients. Conclusion. Guselkumab reduces the incidence of severe complications of Crohn’s disease requiring surgery and inpatient care, as well as reduces the burden of disability. These results demonstrate deep remission as a therapeutic goal in biological therapy.