Economic Impact of Upadacitinib for the Treatment of Moderate-to-Severe Crohn’s Disease and Ulcerative Colitis: Induction and Maintenance Phase 3 Results on Work Productivity Loss

OBJECTIVES: To estimate the economic impact of upadacitinib (UPA) on work productivity related to Crohn’s disease (CD) and ulcerative colitis (UC) using data from UPA induction and maintenance phase 3 trials.

METHODS: Once daily (QD) UPA 45 mg or placebo as induction therapy was administered to CD (12 weeks, U-EXCEL/U-EXCEED) and UC patients (8 weeks, U-ACHIEVE/U-ACCOMPLISH). Those achieving a clinical response were re-randomized to receive QD UPA (15/30 mg) or placebo as maintenance therapy for 52 weeks. Disease impact on work productivity loss (WPL) was measured by Work Productivity and Activity Impairment questionnaire. Treatment difference was measured as changes from baseline to 12 (CD)/8 (UC)- and 52-weeks for UPA vs placebo. Reduction in indirect costs was calculated as hours gained in work productivity times the 2022 US average net compensation ($29.43/hour) for 12/8- and 52-weeks.

RESULTS: In CD, UPA demonstrated significant improvements in WPL at week 12 from baseline for U-EXCEL patients (12.62%, 95% CI [4.58%-20.66%]) and U-EXCEED patients (18.95% [11.54%-26.36%]). UPA also improved WPL at week 52 from maintenance baseline, but the treatment difference was not statistically significant. Compared with placebo, 12-week induction for CD patients had an indirect cost savings of $1,782-$2,677; 52-week maintenance increased this benefit by an additional $6,332-$6,709. In UC, UPA also demonstrated significant improvements in WPL at week 8 for U-ACHIEVE patients (22.20%, 95% CI [15.40%-29.00%]) and U-ACCOMPLISH patients (13.20% [6.50%-20.00%]). At week 52 of maintenance, patients reported significant WPL improvements from maintenance baseline when receiving UPA 15mg QD (15.65%, 95% CI [7.27%-24.02%]) or 30mg QD (16.03% [7.56%-24.50%]). Compared with placebo, 8-week induction for UC patients had an indirect cost savings of $1,243-$2,091; 52-week maintenance increased this benefit by an additional $9,581-$9,814.

CONCLUSIONS: Among patients with moderate-to-severe CD or UC, UPA provided WPL improvements compared with placebo, resulting in substantial indirect cost savings.