番茄社区

WASHINGTON -- Adalimumab (Humira) was more cost-effective in Canada than vedolizumab (Entyvio) or infliximab (Remicade) for treating ulcerative colitis in most cases, researchers said here at the meeting.

At 1 year, the cost of treating an ulcerative colitis patient with adalimumab was $25,148, compared with $30,324 for vedolizumab and $30,932 for infliximab, Candace Beilman, of the University of Alberta, in Edmonton, and colleagues found. At 5 years, the costs were $79,144 for adalimumab, $99,024 for vedolizumab, and $118,014 for infliximab. Effectiveness -- as measured in quality-adjusted life years -- was roughly the same for all three drugs (0.51, 0.47, and 0.54, respectively, at 1 year).

Although biologics have been shown to be effective in inducing and sustaining remission in ulcerative colitis, there is no agreement on which biologic should be used as first-line therapy, the researchers noted in their poster presentation. Costs need to be considered when prescribing such drugs, but little work has been done to ascertain which drug is the most cost-effective.

"Physicians at our center have started to think more about costs recently," Beilman told 番茄社区 in an interview. "In Canada they used to just prescribe whatever because we don't directly see the costs associated with it and patients don't pay out of pocket, so they were just prescribing whichever drug without considering the costs associated with them."

However, "the healthcare budget is restricted, so people are starting to give more attention to this ... Because they have really similar effectiveness a lot of times, this is one more factor that can help physicians choose the best drug for the patient," she said.

To explore the issue further, the investigators constructed a Markov model to simulate the disease course of ulcerative colitis patients. Since the study was performed in Canada, which has a national health insurance program, drug costs were obtained from the Alberta Health Drug Benefit List, with the remaining costs determined from the Canadian Institute for Health Information's Patient Cost Estimator tool, which approximates average costs for inpatient care.

Loss of response and complication rates for vedolizumab, infliximab, and adalimumab were obtained from the GEMINI, ACT, and ULTRA trials, respectively. Due to a lack of long-term data, the main analysis used a time horizon of 1 year, with 5- and 10-year results estimated with extrapolation.

While adalimumab was generally found to be the most cost-effective of the three treatments, there was one exception. Patients on infliximab, which is dosed by weight, had decreased costs if they weighed 50 kg (110 lb) or less -- at $22,922 for 1 year -- so that drug may be more cost-effective for them, the researchers found.

However, "for heavier patients where they need to give them more, the drug becomes more expensive," said Beilman. "That's the kind of thing I don't think many physicians think about when they prescribe the drug, how it changes based on patients' weight, and the costs actually changed quite significantly based on the weight."

As for next steps, "we want to add golimumab (Simponi) [to our analysis] and we want to look at biosimilars, because they're going to change the cost quite a bit," Beilman said. "Hopefully people take into account these costs more than they would otherwise" as a result of the study, she added.

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