OBJECTIVES : The aim of this study was to compare the cost per remission (CPR) of vedolizumab and ustekinumab in anti-tumor necrosis factor (anti-TNF)-naïve and experienced patients with moderate-to-severely active Crohn’s disease from the Brazilian private healthcare system perspective.

METHODS : CPR was estimated considering treatment cost and number needed to treat (NNT) of each therapy at 52 weeks. NNT was calculated using the probability of clinical remission of each therapy (anti-TNF-naïve and experienced settings) obtained from a published Bayesian network-meta-analysis (Hather et al., 2017), which adjusted variability between trials. Data are presented for standard maintenance dosing (vedolizumab: Q8 weeks; ustekinumab: Q12 weeks) and adjusted maintenance dose posology (vedolizumab: Q4 weeks; ustekinumab: Q8 weeks), assuming induction completion. Treatment costs (Brazilian Real, R$) were calculated based on approved posology and prices obtained from magazine price list (October 2019). (Treatment costs – standard dosing: vedolizumab R$116,602, ustekinumab R$176,133; adjusted dosing: vedolizumab R$203,354, ustekinumab R$226,457). Sensitivity analysis evaluated impact of 95% Credible Interval of clinical data.

RESULTS : At 52 weeks, for regular dosing, NNT (sensitivity analysis range) for vedolizumab and ustekinumab, respectively, were 3.8 (3.3-5.0) and 13.3 (6.7-166.7) in anti-TNF-naive patients, and 5.1 (3.5-8.7) and 9.8 (5.3-23.8) in anti-TNF-experienced patients. This equated to a CPR for vedolizumab and ustekinumab, respectively, of R$438,498 (348,755-575,258) and R$2,348,441 (1,174,221-29,355,515) in anti-TNF-naïve patients, and R$592,868 (407,727-1,010,453) and R$1,726,795 (936,878-4,193,645) in anti-TNF-experienced patients. Similar findings were obtained for patients with adjusted dosing (vedolizumab and ustekinumab, respectively): NNT, 4.6 (3.8-6.6) and 6.0 (4.1-11.5) in anti-TNF-naive, and 5.4 (3.6-9.5) and 8.1 (4.7-17.9) in anti-TNF-experienced patients; CPR, R$941,452 (782,129-1,346,713) and R$1,347,957 (939,655-2,602,952) in anti-TNF-naïve, and R$1,093,299 (728,866-1,936,701) and R$1,826,265 (1,058,209-4,043,872) in anti-TNF-experienced patients.

CONCLUSIONS : Based on the Brazilian private healthcare setting, vedolizumab had the lowest NNT and CPR for both standard and dose adjusted posology at 52 weeks versus ustekinumab, among anti-TNF-naive and anti-TNF-experienced Crohn’s disease patients.