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P249. A real life retrospective analysis of drug expenditure reveals no significant cost difference between infliximab and adalimumab in the treatment of adult Crohn's disease

C.A. Lamb1, M. Price2, M. Robinson2, M.C. Gunn2, N.P. Thompson2, J.C. Mansfield2

1University of Newcastle, Newcastle upon Tyne, United Kingdom; 2Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom

Aim: The revised NICE guidance on the use of infliximab and adalimumab for the treatment of Crohn's disease, released in May 2010, has suggested biologics be prescribed as a planned therapy until treatment failure or until completion of 12 months treatment, whichever is shorter. For the first time, NICE have introduced cost as a criteria for which anti TNF antibody treatment should be used, recommending that therapy be commenced with the less expensive of the two drugs. However the comparative cost of the drugs is not immediately clear. For example the dosage of infliximab is weight dependent, whereas the dosage of adalimumab is independent of weight; and the dosage interval of both drugs may be shortened to optimise efficacy. These factors may impact on cost. This retrospective audit aimed to determine the drug costs of infliximab and adalimumab in our patient population.

Methods: As part of a service development exercise, a retrospective audit of patient records was performed. The drug cost of infliximab and adalimumab prescription per patient for the treatment of Crohn's disease in the Trust between 1st April 2009 and 31st March 2010 was calculated.

Figure 1. Box plot of the cost of infliximab and adalimumab per patient for the treatment of Crohn's disease during 1st April 2009 to 31st March 2010.

Results: Of 60 patients receiving biologics, 46 patients were treated with infliximab and 19 patients with adalimumab during the one-year audit period (5 patients received both drugs during the study period). The mean age (range) of the cohort was 32.4 years (17–65). The cost results are summarised in figure 1. The median cost of infliximab was £6294 per patient (mean (95% CI) cost, £6877 (5783, 7971) per patient). The median cost of adalimumab was £5720 per patient (mean (95% CI) cost, £8226 (4893, 11560) per patient). There was no significant cost difference between the drugs (p 0.43).

Conclusions: In our cohort of patients, no significant cost difference was found when comparing infliximab and adalimumab for the treatment of Crohn's disease over a one-year period. In light of the recent NICE guidance, this data would support individual patient and physician choice when deciding on which anti-TNF therapy to prescribe.