OBJECTIVES

: The aim of this study is to compare cost per patient achieving clinical response and cost per remitter patient of adalimumab, ustekinumab and vedolizumab for the treatment of Crohn’s disease (CD) from the Brazilian private payer perspective.

METHODS

: Clinical response was evaluated through CD activity index reduction of 100 points (CDAI-100) and remission rate was evaluated through CD activity index score under 150 points (CDAI<150) in patients with CD. Clinical data of one-year treatment comparing adalimumab, ustekinumab and vedolizumab was obtained from a network metanalysis previously published. Only drug acquisition costs were considered in this analysis, which were obtained from official price magazine, and treatment costs were calculated according to approved label. Cost per patient achieving clinical response and cost per remittent patient were calculated dividing the induction and maintenance year costs by the proportion of patients achieving CDAI-100 and CDAI<150, respectively. In case of dose escalated clinical outcomes, costs were considered accordingly. A hypothetical scenario extrapolating clinical data for a three-year’s time horizon was run.

RESULTS : Costs per patient achieving clinical response for adalimumab, ustekinumab and vedolizumab were: BRL551K, BRL574K and BRL604K in the induction year; BRL477K, BRL355K, BRL490K considering maintenance year costs; and BRL921K, BRL528K BRL962K in the dose escalation scenario. Cost per remitter patient for adalimumab, ustekinumab and vedolizumab were: BRL575K, BRL648K and BRL664K in the induction year; BRL499K, BRL401K and BRL540K considering maintenance year costs; and BRL960K, BRL584K and BRL1,045K in the dose escalation scenario. In the three-year’s scenario analysis, ustekinumab presented the lowest cost per patient achieving clinical response and remittent patient.

CONCLUSIONS : The cost per responder in the first year are roughly similar, the advantage for adalimumab is negligible. Ustekinumab demonstrated to have better outcomes in the scenarios of maintenance year costs and dose escalation data, for both clinical response and remission rate outcomes.