OBJECTIVES The aim of this study is to evaluate the impact of dose escalation on treatment cost of immunobiological therapies for Crohn’s disease from the Brazilian private payer perspective.

METHODS A systematic literature review was conducted on a scientific database, such as an active search, to obtain data of patients’ rate of dose escalation during Crohn’s disease treatment with immunobiological drugs. In Brazil, adalimumab, certolizumab pegol, infliximab, ustekinumab, and vedolizumab have regulatory approval for the treatment of moderate to severe Crohn’s disease, and, except for certolizumab pegol, they all have label indication to increase dosage to manage a lack of or incomplete clinical response. Treatment costs considered were only drug acquisition costs, which were obtained on official magazine price. This analysis considered maintenance drug costs, based on approved labels, for a time horizon of 52 weeks.

RESULTS Dose escalation rates applied on the model for adalimumab, infliximab, ustekinumab and vedolizumab were 36%, 38%, 16% and 18%, respectively. Treatment costs on standard dosages are BRL25,303 for certolizumab pegol, BRL90,496 for vedolizumab, BRL99,891 for adalimumab, BRL99,967 for infliximab, and BRL104,510 for ustekinumab. Once dose escalation rates were considered, treatment costs became BRL106,785 for vedolizumab, BRL112,870 for ustekinumab, BRL128,457 for infliximab, and BRL135,851 for adalimumab, representing an increase of 18%, 08%, 29% and 36% compared to standard dosage, respectively.

CONCLUSIONS Dose escalation demonstrated to impact treatment cost. If only official price is considered, ustekinumab presents the higher treatment cost. However, when dosage adjustment due to incomplete clinical response was considered in the analysis, adalimumab became the most expensive therapy, and ustekinumab presented a lower cost, similar to vedolizumab.