Cost-utility of biological treatment sequences for luminal Crohn’s disease in Europe

ABSTRACT

Background: This study aims to compare the cost-effectiveness of treatment sequences with available biologics, including adalimumab (ADA), biosimilar infliximab (bsIFX), originator infliximab (IFX) and vedolizumab (VEDO) for luminal Crohn’s disease in nine European countries.

Methods: A Markov-model was constructed to simulate five-year medical costs and quality-adjusted life years (QALYs). Data on clinical efficacy were obtained from randomised controlled trials. Country-specific unit costs, discount rates and a third-party payer perspective were applied.

Results: The bsIFX versus conventional therapy resulted in the most favourable incremental cost-utility ratios (ICURs) ranging from €34,580 (Hungary) to €77,062/QALY (Sweden). Compared to bsIFX, the bsIFX-ADA sequence was more cost-effective than the bsIFX-VEDO sequence with ICURs varying between €70,277 (France) and €162,069/QALY (Germany). The ICURs of the bsIFX-ADA-VEDO sequence versus the bsIFX-ADA strategy were between €206,266 (The Netherlands) and €363,232/QALY (Spain).

Conclusion: We are the first to compare cost-effectiveness of multiple biological sequences for luminal Crohn’s disease. Based on our findings, bsIFX can be recommended as a first-line treatment in patients unresponsive to conventional treatments. While biological sequences only slightly differ in their associated health gains, their costs vary greatly. The bsIFX-ADA-VEDO seems to be the most cost-effective sequence of the available biologics across Europe.

KEYWORDS:

• Adalimumab
• biosimilar infliximab
• cost-effectiveness
• Crohn’s disease
• inflammatory bowel diseases
• infliximab
• vedolizumab

Acknowledgments

The authors are grateful to the following collaborators for their valuable advice on the study: Stefan Schreiber (Institute of Clinical Molecular Biology, Kiel University, University Hospital, Kiel, Germany), Petra A. Golovics and Zsuzsanna Végh (Department of 1st Medicine, Semmelweis University, Budapest, Hungary), Silvio Danese (IBD Center, Division of Gastroenterology, Humanitas Clinical and Research Center, Rozzano, Milan, Italy), and Peter Irving (Guy’s and St Thomas’ NHS Foundation Trust, London, UK).

Parts of the results have been presented as an oral presentation at the 24th United European Gastroenterology Week in Vienna (15–19 October 2016):

Rencz F, Brodszky V, Baji P, Pentek M, Gulacsi L, Golovics PA, Vegh Z, Gecse KB, Danese S, Irving P, Lakatos PL. Cost–utility of biosimilar infliximab (Inflectra) for the treatment of luminal Crohn’s disease in nine European countries. United European Gastroenterology Journal 4(5S), A60, OP146. 24th United European Gastroenterology (UEG) Week, 15–19 October 2016. Vienna, Austria

Declaration of interest

F Rencz has served as consultant for Hospira. L Gulácsi has served as a speaker and consultant for Hospira, Pfizer, Celltrion, Sandoz, Astellas, EGIS Pharma, and Sager Pharma. M Péntek has served as a consultant for Hospira, Pfizer, Egis Pharma, and Merck. KB Gecse has served as consultant for AbbVie, Amgen, Ferring, Hospira, MSD, Pfizer, Sandoz, Takeda, and TiGenix. A Dignass has received honoraria or consultation fees from AbbVie, MSD, Ferring, Takeda, Pharmacosmos, Falk, Mundipharma, Allergosan, Hospira, and Sandoz/Hexal, and participated in a company sponsored speaker’s bureau at Falk Foundation, Ferring, MSD, AbbVie, Otsuka, Vifor, Janssen-Cilag, Medice, Mundipharma, and Tillotts Pharma AG. F Gomollón has served as speaker of AbbVie, Kern, MSD, Vifor, and Takeda; and as consultant for Biogen, Pharmacosmos, Grifols, and Kern-Pharma. P Baji has served as a consultant for Hospira, Sager Pharma, Egis Pharma, and Astellas. J Halfvarson has served as a speaker and consultant for Abbvie, Hospira, Janssen, Medivir, MSD, Pfizer, Renapharma-Vifor, and Takeda. L Peyrin-Biroulet has served as consultant for Merck, Abbvie, Janssen, Genentech, Mitsubishi, Ferring, Norgine, Tillots, Vifor, Therakos, Pharmacosmos, Pilège, BMS, UCB-pharma, Hospira, Celltrion, Takeda, Biogaran, Boerhinger-Ingelheim, Lilly, Pfizer, HAC-Pharma, Index Pharmaceuticals, Amgen, Sandoz, Forward Pharma GmbH, Celgene, Biogen, Lycera, and Samsung Bioepis; and a speaker for Merck, Abbvie, Takeda, Janssen, Takeda, Ferring, Norgine, Tillots, Vifor, Therakos, Mitsubishi and HAC-pharma. PL Lakatos has served as a speaker and consultant of AbbVie, Celltrion, Celgene, Ferring, Hospira, Mitsubishi Tanabe Pharma, MSD, Pfizer, Roche, and Takeda. V Brodszky has served as a consultant for Hospira, Egis Pharma, and Sager Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

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Funding

This study was supported by Pfizer Hospira UK Ltd.