OBJECTIVES: Infliximab biosimilar was launched with promises of equivalence efficacy in the moderate-to-severe Crohn’s disease (CD) treatment with lower cost. This study aimed to conduct cost-utility analysis of infliximab and its biosimilar compare to conventional therapy in refractory moderate-to-severe CD treatment in Thailand.

METHODS: Markov model was used to estimate lifetime costs and health benefits of infliximab and its biosimilar using a societal perspective. Our analyses consisted of three choices of treatment (conventional therapy, infliximab originator, and infliximab biosimilar) and three treatment patterns (infliximab 2 years and then 3 years if relapse; infliximab 2 years and then lifelong if relapse; and infliximab lifelong). The input parameters were obtained from CD registry at Thai tertiary care hospitals, Thai health care costs, and systematic literature review. The results were reported as incremental cost-effectiveness ratios (ICERs) in 2017 US Dollars (USD) per quality-adjusted life year (QALY) gained. Sensitivity analyses were performed to assess the influence of parameter uncertainty. Threshold sensitivity analyses were carried out to determine the optimal drug prices. Finally, budget impact analyses were conducted.

RESULTS: None of the scenarios was cost-effective at Thai willingness-to-pay threshold (4,706 USD/QALY gained). The lowest ICERs of 30,121 USD/QALY gained was reported in the scenario that included only standard dose of infliximab biosimilar with 5-year longest duration of treatment. The product prices need to be reduced by 72% and 83% of current prices to allow infliximab biosimilar and originator for being cost-effective choices of treatment, respectively. The 5-year budget impact was only 708,867 USD and 213,453 USD for full and reduced product prices, respectively.

CONCLUSIONS: Infliximab and its biosimilar were not cost-effective for CD treatment in Thailand. This treatment option would be cost-effective if the product prices were significantly decreased. The best value for money treatment strategy was infliximab biosimilar with a restricted duration of treatment.