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. 2016 May 3;3(1):e000093.
doi: 10.1136/bmjgast-2016-000093. eCollection 2016.

Cost-effectiveness of adalimumab, infliximab or vedolizumab as first-line biological therapy in moderate-to-severe ulcerative colitis

Lauren Yokomizo  1 , Berkeley Limketkai  2 , K T Park  3
Affiliations

Cost-effectiveness of adalimumab, infliximab or vedolizumab as first-line biological therapy in moderate-to-severe ulcerative colitis

Lauren Yokomizo et al. BMJ Open Gastroenterol. .

Abstract

Background: There are no head-to-head randomised controlled trials (RCTs) comparing the effectiveness of biologics in ulcerative colitis (UC). We aimed to assess the cost-effectiveness of adalimumab, infliximab and vedolizumab as first-line agents to induce clinical remission and mucosal healing (MH) in UC.

Methods: We constructed a decision tree based on a payer's perspective in the USA to estimate the first year costs of adalimumab, infliximab or vedolizumab to achieve clinical remission and MH in patients with moderate-to-severe UC. Transition probabilities were derived from ACT, ULTRA and GEMINI RCT data. Costs were derived from Medicare reimbursement rates and wholesale drug prices.

Results: Assuming a biological-naïve cohort, infliximab 5 mg/kg every 8 weeks was more cost-effective ($99 171 per MH achieved) than adalimumab 40 mg every other week ($316 378 per MH achieved) and vedolizumab every 8 weeks ($301 969 per MH achieved) at 1 year. Non-drug administration cost of infliximab exceeding $1974 per infusion would make adalimumab more cost-effective. First-line UC therapy with vedolizumab would be cost-effective if the drug acquisition price was <$2537 for each 300 mg administration during the 1-year time horizon.

Conclusions: If non-drug costs of infliximab administration are not excessive (<$2000), infliximab is the most cost-effective first-line biologic for moderate-to-severe UC. Exceeding this threshold infusion-related cost would make adalimumab the more cost-effective therapy. Considering its drug costs in the USA, vedolizumab appears to be appropriately used as a second-line biologic after antitumour necrosis factor failure.

Keywords: COST-EFFECTIVENESS; INFLAMMATORY BOWEL DISEASE; ULCERATIVE COLITIS.

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Figures

Figure 1
Figure 1
Model schematic of competing strategies. *Notes: number of weeks to 1 year. ADA, adalimumab; EOW, every other week; IFX, infliximab; VDZ, vedolizumab.
Figure 2
Figure 2
Cost-effectiveness acceptability curve indicating the proportion of simulations at which each strategy is optimal at various willingness-to-pay thresholds. EOW, every other week; MH,mucosal healing.
See this image and copyright information in PMC

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