Table 4.
Cost-effectiveness analyses of biologic agents for CD
| Intervention, comparator, and target population | Country | Time horizon | Study perspective | ICER ($/QALY) | Reference |
|---|---|---|---|---|---|
| Combination therapy with IFX + AZA at 2.5 mg/kg daily versus IFX monotherapy (IV infusion 5 mg/kg at weeks 0, 2, 6, and every 8 weeks thereafter) in men aged 25 years with biologically naïve CD refractory to conventional non-anti-TNF-α therapy | UK | 1 year | Health care payer | 50,000 | Saito et al58 |
| Top-down strategy: induction treatment of combined immunosuppressive therapy with IFX (2.5 mg/kg/day) and if symptom exacerbation occurred, additional IFX infusions and methylprednisone (32 mg/day for 3 weeks followed by 4 mg/week dose tapering) prescribed versus step-up strategy: induction treatment of methylprednisone and if symptom exacerbation or relapse occurred, AZA and IFX were added to treatment in newly diagnosed patients with luminal CD | Italy | 5 years | Health care payer | Cost-saving | Marchetti et al59 |
| ADA versus CZP in US adult patients aged 35 years with moderate-to-severe CD who failed to respond to standard therapy | US | 54 weeks | Health care payer | Cost-saving | Tang et al60 |
| Natalizumab versus CZP in US adult patients aged 35 years with moderate-to-severe CD who failed to respond to standard therapy | US | 54 weeks | Health care payer | 300,000 | Tang et al60 |
| ADA versus natalizumab in US adult patients aged 35 years with moderate-to-severe CD who failed to respond to standard therapy | US | 54 weeks | Health care payer | Cost-saving | Tang et al60 |
| IFX versus natalizumab in US adult patients aged 35 years with moderate-to-severe CD who failed to respond to standard therapy | US | 54 weeks | Health care payer | Cost-saving | Tang et al60 |
| IFX versus CZP in US adult patients aged 35 years with moderate-to-severe CD who failed to respond to standard therapy | US | 54 weeks | Health care payer | Cost-saving | Tang et al60 |
| Induction therapy of IFX (5 mg/kg) infusions followed by maintenance therapy of IFX (5 mg/kg) infusions every 8 weeks versus induction therapy of ADA (160 mg) subcutaneous injections followed by maintenance therapy of ADA (40 mg) subcutaneous injections every 2 weeks in Canadian patients aged 37 years and weighing 73 kg | Canada | 5 years | Health care payer | 470,000 | Blackhouse et al61 |
| Induction therapy of IFX (5 mg/kg) infusions followed by maintenance therapy of IFX (5 mg/kg) infusions every 8 weeks versus usual care: variety of conventional non-anti-TNF-α treatments including corticosteroids and other immunosuppressants in Canadian patients aged 37 years with refractory CD | Canada | 5 years | Health care payer | 230,000 | Blackhouse et al61 |
| Induction therapy of ADA (160 mg) subcutaneous injections followed by maintenance therapy of ADA (40 mg) subcutaneous injections every 2 weeks versus usual care: variety of conventional non-anti-TNF-α treatments including corticosteroids and other immunosuppressants in Canadian patients aged 37 years and weighing 73 kg | Canada | 5 years | Health care payer | 200,000 | Blackhouse et al61 |
| CZP (400 mg) subcutaneously and continued on monthly maintenance therapy versus natalizumab (300 mg) intravenously every month in US patients aged 35 years with moderate-to-severe CD unresponsive to prior TNF-α antagonists | US | 1 year | Health care payer | 590,000 | Ananthakrishnan et al62 |
| ADA versus IFX in US patients with moderately to severely active CD | US | 56 weeks | Health care payer | Cost-saving | Yu et al63 |
| ADA 2 years of treatment versus standard care in moderate to severely active CD patients in the UK | UK | 60 years | Health care payer | 23,000 | Bodger et al64 |
| ADA 1 year of treatment versus standard care in moderate to severely active CD patients in the UK | UK | 60 years | Health care payer | 16,000 | Bodger et al64 |
| IFX 2 years of treatment versus standard care in moderate to severely active CD patients in the UK | UK | 60 years | Health care payer | 48,000 | Bodger et al64 |
| IFX 1 year of treatment versus standard care in moderate to severely active CD patients in the UK | UK | 60 years | Health care payer | 51,000 | Bodger et al64 |
| ADA (every other week) maintenance treatment versus nonbiologic treatment, placebo (also doses of conventional, nonbiologic medications) in CD patients (in two randomized, double-blind placebo-controlled trails, CHARM and CLASSIC, lifetime model duration) (severe disease groups) | UK | 1 year | Health care payer | 14,000 | Loftus et al65 |
| ADA (every other week) maintenance treatment versus nonbiologic treatment, placebo (also doses of conventional, nonbiologic medications) in CD patients (in two randomized, double-blind placebo-controlled trails, CHARM and CLASSIC, lifetime model duration) (moderately severe disease groups) | UK | 1 year | Health care payer | 38,000 | Loftus et al65 |
| ADA (every other week) maintenance treatment versus nonbiologic treatment, placebo (also doses of conventional, nonbiologic medications) in CD patients (in two randomized, double-blind placebo-controlled trails, CHARM and CLASSIC, 56-week model duration) (moderately severe disease groups) | UK | 1 year | Health care payer | 72,000 | Loftus et al65 |
| ADA (every other week) maintenance treatment versus nonbiologic treatment, placebo (also doses of conventional, nonbiologic medications) in CD patients (in two randomized, double-blind placebo-controlled trails, CHARM and CLASSIC, 56-week base case model) (severe disease group) | UK | 1 year | Health care payer | 34,000 | Loftus et al65 |
| ADA (every other week) maintenance treatment versus nonbiologic treatment, placebo (also doses of conventional, nonbiologic medications) in CD patients (in two randomized, double-blind placebo-controlled trails, CHARM and CLASSIC, 56-week base case model) (severe disease group) | UK | 1 year | Health care payer | 34,000 | Loftus et al65 |
| Maintenance therapy with IFX (5 mg/kg) versus standard care without IFX in adult patients with fistulizing CD in the UK | UK | 5 years | Health care payer | 63,000 | Linsday et al66 |
| Maintenance therapy with IFX (5 mg/kg) versus standard care without IFX in adult patients with active luminal CD in the UK | UK | 5 years | Health care payer | 56,000 | Linsday et al66 |
| Dose escalation of IFX to 10 mg/kg versus IFX discontinued and ADA initiated with a 160 mg injection followed by a 80 mg dose 2 weeks later, maintenance of 40 mg every other week in CD patients who have lost response to standard dose (5 mg/kg) IFX therapy | US | 1 year | Health care payer | 380,000 | Kaplan et al67 |
Notes: Study perspective: The study perspective is the viewpoint from which costs and benefits are calculated. All studies included in our review were conducted from a health care payer perspective and include only direct costs incurred by insurance companies (private or national health care service). Time horizon: The time horizon is the length of time in which resource use (eg, drug use, hospital admissions) are measured. ICER is calculated by dividing the incremental cost by the incremental QALYs gained of an intervention over the examined comparator. An ICER is not calculated when the intervention costs less (cost-saving) and is at least as effective as the comparator. In many of these cases, the intervention is considered “dominant” over the comparator, suggesting that it is both cost-saving and more effective.
Abbreviations: CD, Crohn’s disease; ICER, incremental cost-effectiveness ratio; QALY, quality-adjusted life-year; IFX, infliximab; AZA, azathioprine; IV, intravenous; TNF, tumor necrosis factor; ADA, adalimumab; CZP, certolizumab pegol; CHARM, Crohn’s Trial of the Fully Human Antibody Adalimumab for Remission Maintenance; CLASSIC, CLinical assessment of Adalimumab Safety and efficacy Studied as Induction therapy in Crohn’s disease.