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INDIRECT COMPARISON OF BIOLOGICS IN CROHN'S DISEASE: COST PER REMITTER AND NUMBER NEEDED TO TREAT
M Hubert1, D Parison1, M Martel2, D Lafontaine11Abbott Laboratories, St-Laurent, QC; 2Abbott Laboratories, Abbott Park, Illinois, USA
Aims: As no head-to-head trial has compared the efficacy of biologics for Crohn's disease, an indirect comparison was undertaken in a Canadian setting. Two biologics are currently used to treat moderate to severe active Crohn's disease. In order to distinguish adalimumab from infliximab, CDAI remission rates and annual drug cost were contrasted between them.
Methods: Two methods assessed the cost per remitter, a measure integrating the burden of patients not achieving remission. The first drew on two randomized, double-blind, placebo-controlled trials, namely ACCENT I for infliximab and the Crohn's Trial of the Fully Human Antibody Adalimumab for Remission Maintenance (CHARM) for adalimumab. The absolute risk reduction seen in trial patients generated a number needed to treat in the second method, from which a second cost per remitter was derived.
Results: Using remission rates at week 26 for adalimumab and at week 30 for infliximab, the estimated cost per remitter was $30,393 and $48,205, respectively. The number needed to treat was 4.3 for adalimumab and 5.5 for infliximab, drawing costs per remitter of $52,725 and $104,277, respectively.
Conclusions: The indirect comparison outlines considerable differences in cost and efficacy. Adalimumab is associated with both the lowest number needed to treat and lowest cost per remitter, demonstrating increased value for patients as well as for payers and the Canadian healthcare system.