Advances in Therapy

, Volume 29, Issue 7, pp 620–634

Cost Per Responder Associated with Biologic Therapies for Crohn’s Disease, Psoriasis, and Rheumatoid Arthritis

  • Yifei Liu
  • Eric Q. Wu
  • Arielle G. Bensimon
  • Chun-Po Steve Fan
  • Yanjun Bao
  • Arijit Ganguli
  • Mei Yang
  • Mary Cifaldi
  • Parvez Mulani
Open Access
Original Research

DOI: 10.1007/s12325-012-0035-7

Cite this article as:
Liu, Y., Wu, E.Q., Bensimon, A.G. et al. Adv Therapy (2012) 29: 620. doi:10.1007/s12325-012-0035-7

Abstract

Introduction

Biologic therapies have demonstrated efficacy and safety in several chronic systemic disorders. The authors indirectly compared response rates and costs per responder associated with biologic treatments for moderate-to-severe Crohn’s disease (CD), psoriasis (Ps), and/or rheumatoid arthritis (RA).

Methods

A systematic literature search was performed to identify phase 3 randomized controlled trials of biologics for CD (adalimumab, infliximab), Ps (adalimumab, etanercept, infliximab, ustekinumab 45 mg, ustekinumab 90 mg), or methotrexate-refractory RA (abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab). Food and Drug Administration-approved dosing schedules were evaluated. Published response rates were extracted, with response defined in CD, Ps, and RA as: ≥70-point reduction in CD Activity Index at 12 months; ≥75% improvement in Psoriasis Area and Severity Index at 3 months; and ≥50% improvement in American College of Rheumatology component scores at 6 months. Within each indication, mixed-treatment comparison meta-analyses were conducted to derive pooled estimates and 95% CIs of response rate difference versus placebo for each biologic, adjusting for cross-trial variation in control-arm response rates. Cost per responder was estimated for each biologic as projected per patient drug costs (2011 US$) divided by response rate difference.

Results

Altogether, 23 publications were selected. In CD, 12-month cost per responder was estimated at $116,291 (95% CI $71,637–208,348) for adalimumab and $125,169 (95% CI $60,532–267,101) for infliximab. Among biologics approved in Ps, 3-month cost per responder was lowest for adalimumab ($9,756; 95% CI $8,668–11,131), infliximab ($12,828; 95% CI $11,772–13,922), and ustekinumab 45 mg ($13,821; 95% CI $12,599–15,167). In RA, biologics with the lowest 6-month cost per responder were adalimumab ($27,853; 95% CI $19,284–40,270), etanercept ($29,140; 95% CI $14,170–61,030), and tocilizumab ($31,363; 95% CI $14,713–64,232).

Conclusion

Meta-analyses of clinical trials found considerable variation in cost-effectiveness of biologic therapies for CD, Ps, and RA. These results may help determine biologic utilization in these chronic diseases.

Keywords

Biologic therapy Cost-effectiveness Cost per remitter Cost per responder Crohn’s disease Psoriasis Rheumatoid arthritis 
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Copyright information

© The Author(s) 2012

Authors and Affiliations

  • Yifei Liu
    • 1
  • Eric Q. Wu
    • 2
  • Arielle G. Bensimon
    • 2
  • Chun-Po Steve Fan
    • 2
  • Yanjun Bao
    • 3
  • Arijit Ganguli
    • 3
  • Mei Yang
    • 3
  • Mary Cifaldi
    • 3
  • Parvez Mulani
    • 3
  1. 1.Division of Pharmacy Practice and AdministrationThe University of Missouri — Kansas City School of PharmacyKansas CityUSA
  2. 2.Analysis Group, Inc.BostonUSA
  3. 3.Abbott Laboratories, Inc.Abbott ParkUSA

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