Which is the Most Cost-Effective Treatment for Ulcerative Colitis?

Infusion costs heavily influence the overall cost-efficacy of ulcerative colitis treatment.

Researchers have found that as long as infusion costs are less than $1974, infliximab is the most cost-effective treatment option for patients with moderate-to-severe ulcerative colitis (UC).

If the costs exceed $1974, then adalimumab is the most cost-effective treatment. They also found that due to high drug costs, vedolizumab is best used as a second-line biologic after treatment failure, according to the study published by BMJ Open Gastroenterology.

There are currently no clinical trials that compare the efficacy of the drugs, which can make it difficult to choose the best treatment. Both drugs, adalimumab and infliximab, are antibodies to tumor necrosis factor-α (anti-TNFα).

They are also fist-line treatments for moderate-to-severe UC. The drug vedolizumab was recently deemed a potential first-line treatment, but it is unknown whether the intestinal-specific α4β7 integrin inhibitor is more cost-effective.

The researchers created a decision analytic tree to compare the cost efficacy of the drugs in regard to mucosal healing (MH) at 1 year. They compared the ACT trials for infliximab, the ULTRA trials for adalimumab, and the GEMINI trials for vedolizumab.

All participants included in the current study were biologically-naïve. Researchers found that treatment with infliximab 5-mg/kg every 8 weeks was more cost-effective ($99,171 per MH achieved) compared with adalimumab 40-mg evey other week ($316,378 per MH achieved), according to the study.

They also found that vedolizumab every 8 weeks was the least cost-effective ($301,969 per MH achieved). Researchers used Medicare reimbursement data to determine non-drug costs associated with infliximab infusions, but they note that the cost for private insurance may exceed that.

If the cost is over $1974 for infliximab infusions, adalimumab becomes the most cost-effective option since it is a subcutaneous injection and there are no non-drug costs. The researchers concluded that infliximab is the most cost-effective first-line treatment for patients with moderate-to-severe UC, with the alternative of adalimumab if infusion costs become too costly.