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 public healthcare system perspective.

METHODS : CPR was calculated through the multiplication of treatment cost by patients needed to be treated to achieve clinical remission (number needed to treat - NNT) at 52 weeks. NNT of vedolizumab and ustekinumab was calculated as the inverse of risk difference of each treatment compared to placebo, which was estimated as the difference of the probability of achieving clinical remission with each therapy and with placebo. Probability of clinical remission from anti-TNF-naïve and anti-TNF-refractory patients under treatment on standard dosing (vedolizumab every eight weeks and ustekinumab every twelve weeks) were obtained on a published Bayesian network metanalysis (Hather et al., 2017), which adjusted vedolizumab, ustekinumab and placebo data for variability between trials. Treatment costs (Brazilian Real – R$) were estimated according to approved labels posology and drug prices from official list (October 2019) with mandatory government discount, which results in vedolizumab R$92,776 and ustekinumab R$167,410. A sensitivity analysis was conducted to evaluate the impact of 95% Credible Interval from the probability of clinical remission data.

RESULTS : The NNT (sensitivity analysis range) obtained for vedolizumab and ustekinumab, respectively, were 3.8 (3.3-5.0) and 13.3 (6.7-166.7) in anti-TNF naïve patient population, and 5.1 (3.5-8.7) and 9.8 (5.3-23.8) in anti-TNF refractory patients. CPR of vedolizumab and ustekinumab, respectively, were R$350,097 (307,204-459,286) and R$2,232,138 (1,116,069-27,901,725) in anti-TNF naïve patients, and R$473,346 (325,529-806,746) and R$1,641,278 (890,481-3,985,961) in anti-TNF refractory patients.

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