Cost per remission and cost per response with infliximab, adalimumab, and golimumab for the treatment of moderately-to-severely active ulcerative colitis

Abstract

Objective:

To determine the short-term costs per sustained remission and sustained response of three tumor necrosis factor inhibitors (infliximab, adalimumab, and golimumab) in comparison to conventional therapy for the treatment of moderately-to-severely active ulcerative colitis.

Methods:

A probabilistic Markov model was developed. This included an 8-week induction period, and 22 subsequent 2-week cycles (up to 1 year). The model included three disease states: remission, response, and relapse. Costs were from a Canadian public payer perspective. Estimates for the additional cost per 1 year of sustained remission and sustained response were obtained.

Results:

Golimumab 100 mg provided the lowest cost per additional remission ($935) and cost per additional response ($701) compared with conventional therapy. Golimumab 50 mg yielded slightly higher costs than golimumab 100 mg. Infliximab was associated with the largest additional number of estimated remissions and responses, but also higher cost at $1975 per remission and $1311 per response. Adalimumab was associated with the largest cost per remission ($7430) and cost per response ($2361). The cost per additional remission and cost per additional response associated with infliximab vs golimumab 100 mg was $14,659 and $4753, respectively.

Conclusions:

The results suggest that the additional cost of 1 full year of remission and response are lowest with golimumab 100 mg, followed by golimumab 50 mg. Although infliximab has the highest efficacy, it did not exhibit the lowest cost per additional remission or response. Adalimumab produced the highest cost per additional remission and response.

Key words::

• Ulcerative colitis
• Anti-TNF
• Markov model
• Cost

Transparency

Declaration of funding

This study was funded by Janssen Inc. Canada based on a submitted protocol.

Declaration of financial/other relationships

ED has received an award for doctoral training from the Canadian Institutes of Health Research (CIHR) Drug Safety & Effectiveness Network. KT has received salary support from the CIHR Drug Safety & Effectiveness Network to develop methods and educational materials on network meta-analysis. KT and JJ have previously consulted to Boehringer Ingleheim, Merck, Pfizer, Novartis, Janssen, Roche, Novo Nordisk, UCB, and Gilead.