A recent study found that, while biologic agents improved outcomes in patients with inflammatory bowel disease, they incurred such high costs that they were deemed cost ineffective, particularly for use as maintenance therapy.
A recent study published in PLOS One found that, while biologic agents improved outcomes in patients with inflammatory bowel disease (IBD), they incurred such high costs that they were deemed cost ineffective, particularly for use as maintenance therapy. However, Nadia Pillai and colleagues at the Institute of Social and Preventive Medicine in Lausanne, Switzerland, noted that, as market prices fall and more biosimilars are introduced, the cost effectiveness of biologic agents may improve: “As patents for older biologic agents expire, biosimilars are entering the market, creating an important opportunity for increasing access and reducing costs.”
In March 2017, the investigators performed an extensive systematic literature search of English-language publications to identify economic evaluations of pharmacological and surgical interventions for adults diagnosed with Crohn’s disease (CD) or ulcerative colitis (UC). They analyzed data from 49 full-text studies (24 of which focus on CD and 25 on UC) to determine costs and incremental cost-effectiveness ratios (ICERs) adjusted to reflect 2015 purchasing power parity (PPP).
With respect to CD, the study found the following:
With respect to UC, the study found the following:
The authors conclude that, while biologic agents help to improve outcomes in terms of quality-adjusted life years and remission rates, at current prices, they do not provide good value for money in the majority of clinical situations compared with conventional therapies. In particular, when administered to maintain remission and when compared with current conventional therapies, biologic agents are not cost effective in both CD and UC.
The authors pointed out that evidence from studies of CD illustrate the potential for biologic agents to be cost effective if initiated early and when the patient’s lifetime clinical management is considered. “Early management of CD with infliximab reduced the rate of relapse and hospitalization compared with patients who received upfront steroids,” they explain. According to the authors, early intervention with biologic agents in patients who are at high risk of complications may provide long-lasting benefit and help alter the clinical course of the disease; stratifying patients based on their risk of complications soon after diagnosis may be one way to ensure the value for money of biologic agents is captured.
Finally, the authors note that the cost effectiveness of individual biologic agents compared with each other remains inconclusive, reflecting a major gap in the literature. They further recommend that future economic models strengthen the existing literature by more accurately reflecting real-world treatment pathways, ensuring that the chronic and dynamic nature of IBD is captured and accounting for both direct and indirect costs incurred by the health system and the patients.