Launching top-down anti-TNF therapy at Crohn’s disease diagnosis is more cost-effective than accelerated step-up care, saving about £1,681 per patient over five years and improving clinical outcomes.

The study was funded by the Wellcome Trust, with authors noting disclosed relationships with pharmaceutical companies.

Limitations include reliance on trial-based discontinuation assumptions beyond the study period, UK generalizability of trial-site pricing, and potential underestimation of real-world outpatient encounters.

Sensitivity analyses show the top-down approach remains the most cost-effective in 98.7% of simulations.

A five-year Markov model compared total costs (drugs, management, hospitalization, surgery) and health benefits (QALYs) between the two strategies.

Source: Nurulamin M. Noor et al., Cambridge University Hospitals NHS Foundation Trust; published online in the Journal of Crohn’s and Colitis.

The authors recommend considering early top-down treatment as standard care for newly diagnosed active Crohn’s disease.

The PROFILE trial enrolled 386 adults with newly diagnosed active Crohn’s disease, randomized to top-down therapy versus accelerated step-up starting with conventional therapies.

Top-down therapy produced an average gain of 0.17 QALYs per patient over five years, with far fewer disease flares (0.6 vs 5.0), shorter hospital stays (2.0 vs 4.7 days), and roughly fourfold fewer surgeries.

Subcutaneous anti-TNF options, especially adalimumab, showed greater cost savings—up to £10,059 per patient over five years.