Study: Vedolizumab In the First Line Brings Down IBD Treatment Costs

Vedolizumab is approved by the FDA for the treatment of moderate to severe Crohn disease (CD) or ulcerative colitis (UC), both forms of inflammatory bowel disease (IBD), who have had an inadequate response or loss of response to immunomodulators, tumor necrosis factor (TNF) inhibitors, or corticosteroid therapy.

A recent study sought to assess the budgetary impact of including vedolizumab in a health plan formulary as a preferred first-line biologic therapy for the treatment of UC and CD rather than only for patients who have previously failed on anti-TNF therapy.

Researchers developed a budget impact model to examine the incremental impact on a health plan’s budget if vedolizumab were to be included among existing preferred first-line biologic treatments. In an effort to reflect current treatment paradigms, researchers modeled the most current treatment options available in potential health plans, including newly approved therapies and biosimilars. “Incorporating a biosimilar in our budget impact analysis of including vedolizumab as a first-line biologic treatment represents a conservative approach, because the use of any biosimilar may result in lower costs for the payer,” wrote the authors.

In order to account for differences among health pans, the study authors considered 3 hypothetical formulary cases before the introduction of vedolizumab:

• Case 1: adalimumab as the existing preferred first-line treatment, infliximab as the preferred second-line treatment
• Case 2: infliximab and adalimumab as the existing preferred first-line and second-line biologic treatments
• Case 3: infliximab as the existing preferred first-line biologic treatment and adalimumab as the preferred second-line treatment

In total, researchers found that adding vedolizumab as a first-line treatment in Case 1’s hypothetical formulary demonstrated the most cost-savings, which increased from $1.63 million in the first year of the experiment to $4.68 million in the third year. For Case 2, the total annual cost savings increased from $587,000 in the first year to $1.69 million in the third year; and from $134,000 to $378,000 in Case 3. Additionally, real-world dose escalation patterns contributed to the observed differences in cost savings across the plans. In Case 1, the introduction of vedolizumab as a preferred first-line treatment substantially saves on treatment costs because it reduces the use of adalimumab more in Case 1 than in the other cases.

“The inclusion of vedolizumab on parity with existing preferred first-line biologic treatments is expected to have a substantial cost-savings impact to a health plan,” wrote the authors. “The cost-savings in this study were most pronounced in Case 1, when vedolizumab was introduced as a parity-preferred treatment alongside adalimumab as first-line treatment and alongside infliximab as second-line treatment.”

Reference

Wilson M, Lucas A, Cameron A, Luo M. Budget impact of adding vedolizumab to a health plan formulary as another first-line biologic option for ulcerative colitis and Crohn’s disease. Am Health Drug Benefits. 2018;11(5):253-262. PMCID: PMC6207303.