Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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

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.

PubMed Disclaimer

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.

References

    1. Centers for Disease Control and Prevention. Inflammatory Bowel Disease (IBD) 2014. (2 July 2014). http://www.cdc.gov/ibd/
    1. Rubin DT, Mody R, Davis KL, et al. . Real-world assessment of therapy changes, suboptimal treatment and associated costs in patients with ulcerative colitis or Crohn's disease. Aliment Pharmacol Ther 2014;39:1143–55. doi:10.1111/apt.12727 - DOI - PubMed
    1. Park KT, Bass D. Inflammatory bowel disease-attributable costs and cost-effective strategies in the United States: a review. Inflamm Bowel Dis 2011;17:1603–9. doi:10.1002/ibd.21488 - DOI - PubMed
    1. Park KT, Colletti RB, Rubin DT, et al. . Health insurance paid costs and drivers of costs for patients with Crohn's disease in the United States. Am J Gastroenterol 2016;111:15–23. doi:10.1038/ajg.2015.207 - DOI - PubMed
    1. Wu M, Sin A, Nishioka F, et al. . Non-drug costs associated with outpatient infliximab administration in pediatric inflammatory bowel disease. Inflamm Bowel Dis 2013;19:1514–17. doi:10.1097/MIB.0b013e318281f4f1 - DOI - PMC - PubMed

LinkOut - more resources