Cost-Effectiveness Analysis of Infliximab Versus Cyclosporine in Steroid-Refractory Acute Severe Ulcerative Colitis

OBJECTIVES: To evaluate the cost-effectiveness of infliximab versus cyclosporine in colectomy-free survival for SR ASUC.

METHODS: A decision tree was developed to model probability of disease remission and colectomy and its associated risk from a U.S. commercial payer perspective over three years. Model inputs were derived from published literature and guided by previous models. Cost-effectiveness was assessed deterministically using incremental cost per quality adjusted life years (QALY). Scenario analyses were performed for one year and two year timeframes, as well as for the use of an infliximab biosimilar. A one-way sensitivity analysis (OWSA) was performed for the upper and lower bound for all inputs.

RESULTS: In the base case and biosimilar scenario, infliximab dominated cyclosporine, yielding more QALYs at a lower cost. In the 1 year and 2 year timeframe scenario analyses, infliximab was found to be at a lower cost with less QALYs in comparison to cyclosporine. The OWSA for the base case was found to be dominant for the upper and lower bound of all inputs.

CONCLUSIONS: This analysis found infliximab to be dominant to cyclosporine with prevention of colectomy in steroid refractory ASUC as the primary outcome in a 3 year timeframe. Future research should be centered around generating evidence around efficacy of alternative biologic agents in inducing remission for this patient population to inform clinical decision-making and potential payer reimbursement.