Comparison of enteral nutritional therapy to induce and maintain remission in paediatric patients with mild-to-moderate Crohn’s disease: a cost-effectiveness analysis in the UK

This study assessed the cost-effectiveness (CE) of a specialised formula versus standard oral nutritional supplements (ONS) for the dietary management of paediatric mild-to-moderate Crohn's disease (CD), from the UK National Health Service (NHS) perspective. We developed a Markov model with five health states (remission, mild-to-moderate, moderate-to-severe, surgery and death), using 8-week cycles and a one-year horizon. A systematic literature review identified treatment effectiveness (clinical remission rates) and health state utilities (Child Health Utility-9 Dimension). Costs were sourced from the British National Formulary and National Tariff Payment System (2024 prices) and included costs of intervention and healthcare resources such as primary and outpatient care, diagnostic tests, accident and emergency care and hospitalisations. Clinical experts validated the model structure and inputs. Deterministic and probabilistic sensitivity analyses (DSA and PSA) assessed the robustness of findings. The base case results demonstrated that specialised formula saves £591 per patient annually while maintaining similar quality-adjusted life-years (QALYs) compared to standard ONS. Additionally, in a cohort of 1,000 patients, 552 would achieve remission with the specialised formula compared to 496 with standard ONS. DSA identified the 8-week intervention costs and utility scores as key drivers of CE. PSA indicated that at a willingness-to-pay threshold of £20,000 per QALY, specialised formula has a 78% likelihood of being CE compared with standard ONS. The main limitation is the lack of published clinical trials comparing specialised formula with standard ONS, along with the overall scarcity of published data on standard ONS. Meta-analysis would be beneficial to validate and strengthen the comparative data; however, due to the limitations of the published data, meta-analysis is not possible at present. Specialised formula is a less costly and more effective treatment compared to standard ONS in mild-to-moderate paediatric CD patients over one year.