P738 The budget impact of early dose optimisation with golimumab in ulcerative colitis in the UK
C. Black*1, A. Hirst2, A. Brandtmüller3, S. Kachroo1, A. Puenpatom3
1Merck & Co., Inc., Kenilworth, USA, 2ICON PLC, Dublin, Ireland, 3MSD, Budapest, Hungary
The PURSUIT study found that ulcerative colitis patients who were non-responders (based on full Mayo score) to subcutaneous golimumab treatment at Week 6 may benefit from receiving a dose of 100 mg golimumab from Week 6 onwards, with 28% of non-responders at Week 6 becoming responders by Week 14. The aim of this study was to assess the budget implications of optimising a patient’s dose at Week 6 compared with other first-line therapies as per current clinical practice
A decision tree model was designed to follow a patient’s response to first-line treatment and to track a patient’s progression through subsequent line of therapy. The budget impact model only considered drug costs from the perspective of the UK NHS. In total three lines of therapy were covered by the decision tree over a 1 year time horizon. Patients could have first-line treatment with one of the three treatment strategies; golimumab (current treatment practice), golimumab (dose optimisation based on the PURSUIT trial) and adalimumab. Within each of the comparator treatments dose escalation was considered, based on the median time to escalation and proportion of patients receiving dose escalation. Subsequent therapy for golimumab patients was adalimumab and patients who received adalimumab as a first-line therapy received golimumab as a second-line therapy. Response rates, time to loss of response and treatment costs were taken from published data sources. The cost of golimumab was equal between 50 mg pack and 100 mg pack. The model used assumption for second-line response rates; this has been tested in sensitivity analysis.
The use of dose optimisation for golimumab does not increase expenditure of drug costs compared with golimumab (single dose) with a cost saving of £42 per patient per year. When comparing dose optimisation for golimumab to adalimumab, golimumab was cost saving over 1 year of treatment with cost saving of £2138 per patient. The number of patients in a response health state was similar across all three treatments (47.7%, 47.6% and 45% for golimumab (single dose), golimumab (dose optimisation) and adalimumab, respectively.
The implementation of dose optimisation at Week 6 for golimumab was cost saving compared with golimumab (current treatment practice) or adalimumab. The analysis highlights the need for immediate implementation of the updated GLM label in clinical practice for potentially more cost savings.