Infliximab Saves on Short-Term Costs in ASUC, and Biosimilars Could Help

Acute severe ulcerative colitis (ASUC) can occur in up to 25% of patients with UC. Salvage therapy with infliximab or cyclosporine is standard first-line therapy for patients who do not respond adequately to intravenous corticosteroids, but questions have arisen about the cost-effectiveness of this approach versus early colectomy. A recent study, conducted in a tertiary hospital network in Australia, sought to compare healthcare utilization and costs between patients with ASUC who had early colectomy and those who were treated with infliximab.

The retrospective cohort study considered 118 patients with ASUC treated between 2004 and 2014 who received either infliximab (n = 85) or colectomy (n = 33) as first-line therapy, with the choice of treatment given at the discretion of the treatment team. Long-term followup was conducted from the date of the first infusion or surgery through the end of 2016. Costs were estimated from the perspective of a third-party payer.

The investigators found that of the 85 patients who received infliximab, 41% later required a colectomy, with 86% of the surgeries occurring within 12 months of admission for ASUC. For patients who received infliximab, 45% received a single dose, while 31% and 24% received 2 and 3 doses, respectively.

Inpatient healthcare utilization was not significantly different between the infliximab group and the colectomy group in terms of median number of admissions (7.0 vs 4.5; P = .22), the median length of inpatient stay in days (24 vs 29; P = .44), or the median number of outpatient visits after ASUC (7.0 vs 6.0; P = .77).

The mean total healthcare costs—including hospitalization, medications, procedures, and outpatient visits&mdash;were significantly lower for the infliximab group than for the colectomy group at 30 days until 6 months after the initial admission; converted into US dollars, costs were $7340 versus $14,465 (P <.001) at 30 days and $12,525 versus $17,624 (P = .003) at 6 months for the infliximab and colectomy groups, respectively. Mean costs between groups did not differ from 1 year until 7 years, however.

The investigators also performed an assessment of biosimilar anti—tumor necrosis factor therapies, comprising biosimilar infliximab and biosimilar adalimumab, based on hypothetical cost reductions of 50% and 70% (at the time of the paper’s writing, local pharmacies were able to purchase biosimilar infliximab at a 59% discount to the reference product under Australia’s Pharmaceutical Benefits Scheme).

While at year 7, there was no significant difference in cost for biosimilar-treated patients versus those who received colectomy, there was a reduction in the mean cost of biologic treatment; using a biosimilar reduced costs by $7746. According to the authors, less expensive biosimilar agents will likely have an impact on overall costs, and will possibly make anti-TNF therapy favorable versus colectomy because of their cost-saving potential.

“In an era of cost containment and growing concerns for the sustainability of exponentially increasing biologic usage worldwide, this study is the first to our knowledge that shows the consistent, durable reduction in long-term healthcare utilization achievable with an infliximab-first approach in ASUC,” conclude the authors.

Reference

Vasudevan A, Arachchi A, Scanlon C, Greenhalgh J, Van Langenberg DR. A comparison of long-term healthcare utilization and costs in patients with acute severe ulcerative colitis receiving infliximab versus early colectomy [published online January 29, 2019]. Ther Adv Chronic Dis. doi: 10.1177/2040622319825595.