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

Abstract

BackgroundThere 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.MethodsWe 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.ResultsAssuming 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.ConclusionsIf 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.

Declining hospitalisation and surgical intervention rates in patients with Crohn's disease: a population‐based cohort

“…Newer treatment algorithms that focus on achieving mucosal healing as opposed to symptomatic control will increase the use of biologic therapies . A recent report estimated the cost of achieving mucosal healing in a biologically naïve cohort of CD in the USA to range between $99 171 and $316 378 in the first year of use . There are conflicting data regarding the relative contribution of hospitalisation and surgery to total health care costs in CD, with more recent literature tending to favour medication, and particularly TNF antagonist therapy as the major driver of costs .…”

“…20 There are conflicting data regarding the relative contribution of hospitalisation and surgery to total health care costs in CD, with more recent literature tending to favour medication, and particularly TNF antagonist therapy as the major driver of costs. 9,20 We would expect this trend to continue with the introduction of newer biologics such as vedolizumab and ustekinumab, as well as targeted small molecules, and the fact that the marginal costs savings associated with biosimilars in North America are likely to preclude their widespread uptake. The costs associated with the use of biologic therapies must be balanced with decreases in the costs associated with hospitalisations and surgeries, important goals of therapy for both patients and health care providers.…”

Cost-effectiveness of biological treatment of ulcerative colitis – a systematic review

“…QALY was the endpoint of eight analyses [18, 19, 21–23, 25–27], remission and response was used in one study [24], and mucosal healing in another one [20]. The most commonly assessed biological agent was infliximab – eight studies [18–20, 23–27].…”

Conserved transcriptomic profile between mouse and human colitis allows temporal dynamic visualization of IBD-risk genes and unsupervised patient stratification

“…The identification of UC2 which is characterized by responsiveness to both IFX and VDZ may have direct implications in the clinical setting. For example, it indicates that UC2 patients would benefit from a treatment with IFX only, since IFX therapy has a higher response rate 6 and is more cost-effective compared to VDZ 39 . On the other hand, identification of non-responsiveness to both IFX and VDZ in the UC1 patient subgroup, suggests that another line of therapy should be applied.…”