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P331. Cost-effectiveness of infliximab for the treatment of acute exacerbations of ulcerative colitis in The Netherlands

M.A. Chaudhary1, K.Y. Westerhout2, T. Fan3, C. Vos4, J.F.S. Logman4, B.G. Verheggen2

1Merck & Co., Inc., North Wales, PA, United States; 2Pharmerit International, Rotterdam, The Netherlands; 3Merck & Co., Inc., Whitehouse Station, NJ, United States; 4Merck Sharpe & Dohme BV, Haarlem, The Netherlands

Aim: To evaluate the cost-effectiveness of infliximab versus cyclosporine and surgery for the treatment of adult Dutch patients hospitalized with acute exacerbations of ulcerative colitis (UC), refractory to intravenous corticosteroids.

Materials and Methods: The biological therapy infliximab (Remicade®) is an inhibitor of tumour necrosis factor α (TNF-α), a cytokine that plays a major role in the pathogenesis of UC. Infliximab has been shown to be efficacious in the treatment of acute exacerbations of UC. Additionally, infliximab induction regimen was shown to be a cost-effective treatment option for UC patients hospitalized with an acute exacerbation in the United Kingdom. We used a decision analytical model to simulate disease progression of Dutch acute UC patients, refractory to intravenous corticosteroids and to estimate the costs and benefits associated with infliximab, cyclosporine and surgery over a one-year time horizon. The goal of treatment was to avoid colectomy and induce remission. Transition probabilities were derived from infliximab and cyclosporine randomized trials, using indirect comparison. Resource use and drug use frequencies as well as unit costs were obtained from Dutch sources. Only direct medical costs were included in the analyses as data specific for these treatment options on the indirect costs (such as productivity losses) were not available. The primary effectiveness measure used in the analysis was quality adjusted life years (QALYs). The utility estimates associated with health states of UC patients were obtained from the literature. Costs were discounted at 4.0% and outcomes at 1.5%. One-way and probabilistic sensitivity analyses were performed to assess the uncertainty surrounding the results.

Results: For a typical UC patient with body weight of 70 kg, the costs of treatment with infliximab, cyclosporine, and surgery over a one year treatment period were €17,062, €14,784, €13,979, respectively. The associated numbers of QALYs were 0.80, 0.70, and 0.58 for infliximab, cyclosporine and surgery respectively. The incremental cost effectiveness ratio (ICER) for infliximab was €24,277 per QALY gained compared to cyclosporine, and €14,639 per QALY gained compared to surgery. Univariate sensitivity analysis showed that the results were especially sensitive to changes in efficacy estimates, baseline body weight, utility estimates, and the time horizon of analysis. Probabilistic sensitivity analyses showed that at a cost-effectiveness threshold of €30,000 per QALY, infliximab had a 55% and 79% probability of being cost-effective compared to cyclosporine and immediate surgery, respectively.

Conclusion: Infliximab induction regimen appears to be a cost-effective treatment option in comparison to cyclosporine and surgery for hospitalized patients with acute exacerbations of UC, refractory to intravenous corticosteroids in the Netherlands.