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Journal of Crohn's and Colitis: 9 (8)

Editor-in-Chief

Laurence J. Egan, Ireland

Associate Editors

Maria T. Abreu, USAShomron Ben-Horin, IsraelSilvio Danese, ItalyPeter Lakatos, HungaryMiles Parkes, UKGijs van den Brink, NLSéverine Vermeire, Belgium

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Costs of adalimumab versus infliximab as first-line biological therapy for luminal Crohn's disease

Grace K.H. Choi, Stephanie D.E. Collins, Daniel P. Greer, Lisa Warren, Grace Dowson, Tanya Clark, P. John Hamlin, Alexander C. Ford
DOI: http://dx.doi.org/10.1016/j.crohns.2013.09.017 375-383 First published online: 1 May 2014

Abstract

Background and aims Randomised controlled trials demonstrate that the anti-tumour necrosis factor-α (anti-TNFα) therapies infliximab and adalimumab are effective in inducing remission and preventing relapse of Crohn's disease (CD). As few studies have compared costs and efficacy of these two drugs directly, we examined this issue.

Methods Data were collected for patients receiving either drug as first-line anti-TNFα for CD. Patients were matched as closely as possible on age, gender, weight, height, and date of commencement of therapy. Response to induction therapy was assessed at 12 weeks, and sustained clinical benefit at last point of follow-up. Resource data were collected for all patients until study end, with National Health Services reference costs applied to calculate the total cost per patient with adalimumab compared with infliximab.

Results Thirty-six patients had been treated with adalimumab as first-line anti-TNFα since 2010. We matched an identical number of infliximab patients. Demographic data were similar between the two groups. Costs were significantly lower with adalimumab (£6692.95 less per patient (95% confidence interval £1816.61–£11569.29)), which was largely driven by the drug costs and drug administration costs associated with infliximab. Twenty-nine (80.6%) patients responded to induction therapy with both drugs, and 22 (61.1%) achieved glucocorticosteroid-free sustained clinical benefit with either drug at last point of follow-up.

Conclusions Costs of infliximab used as first-line anti-TNFα therapy are greater, which may have implications for selection. Clinical outcomes appeared comparable, although power to detect a statistically significant difference would be limited.

Keywords
  • Crohn's disease
  • Adalimumab
  • Infliximab
  • Abbreviations
    CD
    Crohn's disease
    CI
    confidence interval
    CT
    computed tomography
    EUA
    examination under anaesthesia
    HBI
    Harvey-Bradshaw index
    IBD
    inflammatory bowel disease
    kg
    kilogramme
    MRI
    magnetic resonance imaging
    NICE
    National Institute for Health and Care Excellence
    NNT
    number needed to treat
    OGD
    oesophagogastroduodenoscopy
    RCT
    randomised controlled trial
    SD
    standard deviation
    TNFα
    tumour necrosis factor-α.
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