Cost-utility analysis of biologic treatments for moderate-to-severe Crohn's disease
Derek H Tang1, Edward P Armstrong, Jeannie K Lee
1Department of Pharmaceutical Sciences, University of Arizona College of Pharmacy, Tucson, AZ 85721, USA.
Insights
For moderate-to-severe Crohn's disease, infliximab offers the highest probability of being the most cost-effective biologic treatment. This analysis compared infliximab, adalimumab, certolizumab pegol, and natalizumab from a US payer perspective.
Area of Science:
- Gastroenterology
- Pharmacoeconomics
- Health Outcomes Research
Background:
- Crohn's disease (CD) is a chronic inflammatory bowel disease.
- Biologic therapies are recommended for moderate-to-severe CD refractory to standard treatments.
- Comparative cost-effectiveness data for biologics are crucial for payer decision-making.
Purpose of the Study:
- To compare the cost-effectiveness of four guideline-recommended biologic treatments for Crohn's disease.
- Evaluate infliximab, adalimumab, certolizumab pegol, and natalizumab from a United States payer perspective.
- Determine the most cost-effective initial biologic therapy for CD.
Main Methods:
- A cost-utility decision analytic model utilizing Monte Carlo simulation (10,000 cases).
- Data sourced from published primary and tertiary literature.
- Model included patients with moderate-to-severe CD, treatment-naive to biologics.
Main Results:
- All four biologics demonstrated similar quality-adjusted life years (QALYs) gained (0.79-0.80).
- Infliximab had the lowest median cost ($22,663), though confidence intervals overlapped with other agents.
- Cost-effectiveness acceptability curve showed infliximab had the highest probability (95.2%) of being most cost-effective at a $100,000/QALY threshold.
Conclusions:
- Infliximab is the preferred initial biologic treatment for patients with moderate-to-severe Crohn's disease.
- This recommendation is based on its highest probability of being the most cost-effective option.
- Cost-effectiveness analysis supports infliximab as a valuable therapeutic choice.
Study Objective:
To compare the cost versus utility of four guideline-recommended biologic treatments-infliximab, adalimumab, certolizumab pegol, and natalizumab-for the treatment of Crohn's disease from a United States payer perspective.
Design:
Cost-utility decision analytic model using a Monte Carlo simulation of 10,000 cases.
Data Source:
Published primary and tertiary literature.
Patients:
Patients with moderate-to-severe Crohn's disease, as categorized by the Crohn's Disease Activity Index, that failed to respond to standard therapy and who were treatment naive to biologics.
Measurements And Main Results:
The decision analytic model base case was a 35-year-old patient weighing 70 kg with moderate-to-severe Crohn's disease. Therapeutic efficacy data were obtained from published clinical trials. Online prescription drug, hospitalization data, and Current Procedural Terminology codes were used to estimate cost. Utility measures were estimated using published data obtained from patients with Crohn's disease. The time end point used for the model was 54 weeks. The analysis demonstrated considerable overlap in quality-adjusted life years gained with the four agents (i.e., mean values across four treatments 0.79-0.80). Although infliximab had the lowest median cost, there was overlap in the 95% confidence intervals (CIs) compared with the other three biologic products: mean (95% CI) cost for infliximab $22,663 ($19,105-26,433), adalimumab $27,515 ($23,796-31,584), certolizumab pegol $29,062 ($24,952-33,882), and natalizumab $31,166 ($25,915-37,195). However, the cost-effectiveness acceptability curve demonstrated that infliximab had the most scenarios (95.2%) when it was the most cost-effective biologic therapy using a willingness-to-pay threshold of $100,000/quality-adjusted life years gained.
Conclusion:
Patients with moderate-to-severe Crohn's disease that failed to respond to standard treatment should preferentially receive infliximab as their initial biologic treatment, since this agent had the highest probability of being the most cost-effective therapy compared with the other biologic treatment options.
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