Costs of adalimumab versus infliximab as first-line biological therapy for luminal Crohn's disease

Background and aims Randomised controlled trials demonstrate that the anti-tumour necrosis factor-alpha (anti-TNF alpha) therapies infliximab and adalimumab are effective in inducing remission and preventing relapse of Crohn's disease (CD). As few studies have compared costs and efficacy of these two drugs directly, we examined this issue. Methods Data were collected for patients receiving either drug as first-line anti-TNF alpha for CD. Patients were matched as closely as possible on age, gender, weight, height, and date of commencement of therapy. Response to induction therapy was assessed at 12 weeks, and sustained clinical benefit at last point of follow-up. Resource data were collected for all patients until study end, with National Health Services reference costs applied to calculate the total cost per patient with adalimumab compared with infliximab. Results Thirty-six patients had been treated with adalimumab as first-line anti-TNF alpha since 2010. We matched an identical number of infliximab patients. Demographic data were similar between the two groups. Costs were significantly lower with adalimumab (6692.95 pound less per patient (95% confidence interval 1816.61- pound 11569.29)) pound, which was largely driven by the drug costs and drug administration costs associated with infliximab. Twenty-nine (80.6%) patients responded to induction therapy with both drugs, and 22 (61.1%) achieved glucocorticosteroid-free sustained clinical benefit with either drug at last point of follow-up. Conclusions Costs of infliximab used as first-line anti-TNF alpha therapy are greater, which may have implications for selection. Clinical outcomes appeared comparable, although power to detect a statistically significant difference would be limited.