Objectives: The aim of this study was to compare the cost-per-responder of ustekinumab versus all other biologic treatments for ulcerative colitis (UC) available in the Netherlands (infliximab [IFX], IFX biosimilar, adalimumab [ADA], ADA biosimilar, vedolizumab [VEDO] and golimumab [GOL]).

Methods: A cost-per-responder analysis was developed evaluating a hypothetical cohort of 1,000 patients with moderate-to-severe UC. Two populations were modelled: the biologic-failure and biologic-naïve population. A two-year time horizon was selected for the analysis. The model adopted the payer perspective in the Netherlands. Clinical efficacy of comparators was estimated through a network meta-analysis (NMA) utilizing data from the pivotal clinical trials of the biologic treatments. Resource use was based on dosing schedules outlined in the summary of product characteristics (SmPC) of each treatment. Acquisition and administration costs were derived from the Dutch Healthcare Authority (NZa) and Dutch drug database (G-standaard) using list prices excl. VAT.

Results: In the biologic-naïve population, ustekinumab q12w (i.e. initial recommended SmPC dosing) demonstrated consistently lower cost-per-responder results (€57,460.27) compared to all other biologic treatments in moderate-to-severe UC, with cost-per-responder results ranging from €72,531.36 (VEDO 300mg q8w) to €116,104.35 (GOL 50mg q4w). Ustekinumab q8w (i.e. escalated dose in SmPC) demonstrated lower cost-per-responder results (€95,087.17) than ADA 40mg q2w (€101,430.14), VEDO 300mg q4w (€128,897.94), and both dosing regimens of GOL (50mg q4w: €116,104.35; 100mg q4w: €111,331.40) in the biologic-naïve population. In the biologic-failure population, ustekinumab q12w (€109,972.53) demonstrated lower cost-pe-responder results than both doses of VEDO (300mg q8w: €137,579.79; 300mg q4w: €225,989.82) and similar cost-per-responder results to ADA 40mg q2w (€106,961.76).

Conclusion: Based on the results of the cost-per-responder analysis, ustekinumab provides a cost-effective treatment option for the treatment of moderate-to-severe ulcerative colitis as compared to other biologics currently available in the Netherlands.