OBJECTIVES : Current clinical practice in managing Ulcerative Colitis (UC) includes biologic treatment with anti-TNF, anti-IL 12/23 and anti-integrin drugs. This study aims to compare cost per responder of each mechanism of action (MoA) for UC biologic naïve patients from the Brazilian private payer perspective through clinical response and remission rates

METHODS : Three drugs with different MoA were compared: adalimumab (anti-TNF), ustekinumab (anti-IL 12/23), and vedolizumab (anti-integrin). A published network metanalysis was accessed to compare each biologic drug clinical outcomes. Clinical response and clinical remission rates were evaluated through changes in total Mayo score and its subscores in biologic naïve patients. Only drug costs were considered, which were obtained on official price lists, and calculated according to label. Cost per patient achieving clinical response and cost per remittent patient were calculated through the ratio of costs (induction and maintenance year for standard and optimized dosing) by the proportion of patients achieving each outcome. For a three-year time horizon, clinical data were considered the same, but costs calculated accordingly

RESULTS : Cost per biologic naïve patient achieving clinical response, in induction, maintenance standard and maintenance optimized year costs, were respectively: adalimumab BRL809K, BRL701K, BRL1.40M; ustekinumab BRL 249K, BRL154K, BRL231K; vedolizumab BRL317K, BRL257K, BRL515K. Cost per remittent patient, in induction, maintenance standard and maintenance optimized year costs, were respectively: adalimumab BRL689K, BRL597K, BRL1.19M; ustekinumab BRL 415K, BRL257K, BRL385K; vedolizumab BRL402K, BRL327K, BRL654K. In the 3-years scenario analysis, ustekinumab presented the lowest cost per responder result for clinical response (BRL557K, BRL711K) and remission (BRL 929K, 1.18M) for standard and optimized dosing, respectively.

CONCLUSIONS : Anti-IL12/23 showed favorable economic results compared to other MoA. Among biologic treatments for UC in bionaïve patients, ustekinumab demonstrated to have the most favorable cost per responder result in the majority of analysis for both outcomes, considering induction, maintenance and 3-year time costs.