Presentation (CTI)

OBJECTIVES: Crohn’s disease(CD) is a progressive disease, characterized by transmural inflammation, and it may involve any portion of luminal gastrointestinal tract. Disease progression often times leads to surgery. Although intravenous (IV) infliximab is an established therapy, its peak-to-trough pharmacokinetic fluctuations can lead to an inadequate treatment response. Recently developed subcutaneous (SC) infliximab provides sustained drug exposure. Real-world evidence including the REMSWITCH study and recent clinical cohorts demonstrates that patients with an inadequate IV response can derive clinical benefits from switching to the SC formulation even during the maintenance phase. Anticipating Japanese regulatory approval in 2027, the objective of this study is to evaluate cost-effectiveness of infliximab subcutaneous over adalimumab in Japanese healthcare.
METHODS: A Markov model was created to compare treatment cost and effecacy of two biologic drugs: infliximab(Zymfentra) and adalimumab(Humira), and surgery or standard of care as the last line of treatment. Outcomes of the model included costs for public payer, quality-adjusted life years(QALYs), life years in remission, and life years in response. Published data including network meta-analysis were incorporated in the parameters.
RESULTS: Over 10-years’ time horizon, treatment of infliximab subcutaneous had better health outcomes results in comparison to adalimumab including higher QALYs with an incremental gain of 0.0928 QALYs, and an additional 0.3476 life years in remission. Total yearly biologics costs were JPY 225,683 lower for subcutaneous infliximab than for adalimumab. Total treatment costs(pharmacotherapy, disease management, surgery, adverse events treatment) were JYP 471,260 lower for infliximab subcutaneous over the 10-year time frame. As subcutaneous infliximab generated greater health benefits at lower costs, adalimumab was dominated. In the deterministic sensitivity analysis, effectiveness of infliximab subcutaneous was the most sensitive variable.
CONCLUSIONS: In a treatment landscape where patients may experience disease progression while exhausting available biologic options, subcutaneous infliximab could represent a valuable alternative that supports both disease control and cost-containment over adalimumab.