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Anti-tumor necrosis factor therapy (ant-TNF) has dramatically changed the treatment of both Crohn’s disease (CD) and ulcerative colitis (UC). The efficacy of this class of therapy has been established since the late 1990s when infliximab was shown to be effective in the treatment of moderate to severe CD and later fistulizing CD and UC (1-4). Since this time, additional anti-TNF agents have demonstrated efficacy in moderate to severe inflammatory bowel disease (IBD), including adalimumab (5,6) for both CD and UC and golimumab (7,8) for UC. In addition, several studies have further demonstrated the long-term efficacy of these agents based on both randomized controlled trials (RCT) and real-world data (9-11). While anti-TNF therapy has offered an effective treatment option for both CD and UC, the associated high costs of using these agents is often considered a drawback from a population standpoint. Several studies have demonstrated that the increased cost associated with using anti-TNF therapy has now surpassed hospitalization and surgery as the highest healthcare expenditure in patients with IBD (12-14).

The cost and benefit of anti-TNF therapy from a population perspective—for what it’s worth