Cost Per Clinical Remission and Clinical Response of Adalimumab, Golimumab, and Infliximab in the Treatment of Patients with Ulcerative Colitis: An Induction Analysis

Abstract

Purpose: Adalimumab (ADA), golimumab (GLM), and infliximab (IFX) are anti-tumor necrosis factor (anti-TNF) therapies approved for treating ulcerative colitis (UC). No study has compared the cost effectiveness of all three of these therapies. This study compares the cost per clinical remission (CPR) and cost per clinical response (CPRes) for the induction period for ADA, GLM, and IFX in patients with UC who were anti-TNF naïve. Methods: Since the induction periods differed across the five randomized clinical trials that examined the efficacy of these treatments (8 weeks for ADA and IFX, 6 weeks for GLM), it was necessary to make assumptions as to how the placebo-adjusted efficacy rates would change over time. The five randomized clinical trials include two for ADA (ULTRA 1 and 2), one for GLM (PURSUIT), and two for IFX (ACT 1 and 2). In particular, we assumed that the efficacy for GLM would change via a linear function, concave function, or convex function between weeks 6 and 8. We performed a similar analysis, this time adjusting the IFX and ADA efficacy estimates from 8 weeks to 6 weeks to align with the GLM induction period. Treatment costs were calculated by applying the May, 2013 wholesale acquisition costs based on labeled dosing requirements. Infusion administration costs were included for IFX. Results: The CPR for GLM was $57,861, assuming that GLM would increase linearly, compared to $32,371 and $27,435 for IFX (ACT 1 and 2) and $94,193 and $85,048 for ADA (ULTRA 1 and 2). The CPR for GLM was $43,396 and $66,763, assuming concave and convex adjustment, respectively. The CPRes results were similar (Table 1). The results remained consistent for ADA and IFX when examining a 6-week, as opposed to an 8-week, induction period.Table 1: Results of cost per clinical remission and clinical response analysesConclusion: IFX and GLM had lower CPR and CPRes compared to ADA in the treatment of ulcerative colitis after adjusting for the different lengths of induction periods. Disclosure - Dr. Peter Mallow-Consultant: Janssen Scientific Affairs, LLC; Dr. John Rizzo-Consultant: Janssen Scientific Affairs, LLC; Dr. Mary Kay Queener-Employee: Janssen Scientific Affairs, LLC; Timothy Gathany-Employee: Janssen Research and Development; Dr. Jennifer Lofland-Employee: Janssen Scientific Affairs, LLC. This research was supported by an industry grant from Janssen Scientific Affairs, LLC.