Cost-effectiveness of adalimumab, infliximab or vedolizumab as first-line biological therapy in moderate-to-severe ulcerative colitis
- PMID: 27195130
- PMCID: PMC4860720
- DOI: 10.1136/bmjgast-2016-000093
Cost-effectiveness of adalimumab, infliximab or vedolizumab as first-line biological therapy in moderate-to-severe ulcerative colitis
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.
Figures


References
-
- Centers for Disease Control and Prevention. Inflammatory Bowel Disease (IBD) 2014. (2 July 2014). http://www.cdc.gov/ibd/
-
- 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
-
- 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
-
- 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
-
- 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
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources