OBJECTIVES: To evaluate the cost of tofacitinib, ustekinumab, vedolizumab, infliximab biosimilar, and adalimumab among patients with moderately-to-severely active ulcerative colitis who have had an inadequate response or are intolerant to tumor necrosis factor (TNF) blockers

METHODS: An Excel-based, decision-analytic model was developed to evaluate costs from the perspective of a third-party payer in the United States (US) over two years. All patients started induction therapy and continued treatment if they met the criteria for clinical response after induction, achieved remission after maintenance (based on Mayo score criteria), and did not experience a serious adverse event (AE). Patients who did not meet these criteria switched to the next line of treatment. Response and remission rates were informed by US prescribing information. Costs were reported in 2019 US dollars and included drug wholesale acquisition costs and costs related to drug administration, monitoring, healthcare resource utilization, and treatment for AEs. The size of the eligible population was based on the number of members in a payer organization and on published epidemiological data.

RESULTS: The analysis compared treatment strategies starting with tofacitinib against those starting with ustekinumab or vedolizumab for TNF-experienced patients. The cost per member per month (PMPM) of tofacitinib followed by vedolizumab, infliximab biosimilar, or adalimumab ($1.46 to $1.67) was lower than that of ustekinumab followed by the same treatments ($1.89 to $2.12; ∆ = -$0.43 to -$0.45). Similarly, the use of tofacitinib before ustekinumab, infliximab biosimilar, or adalimumab ($1.46 to $1.75) was associated with a lower PMPM cost than the use of vedolizumab before the same treatments ($1.60 to $1.97; ∆ = -$0.14 to -$0.22). Sensitivity analyses considered uncertainty around parameters and suggested confidence in the results from the main analyses.

CONCLUSIONS: This analysis suggested that the use of tofacitinib among TNF-experienced patients would be a cost-saving option for US payers.