Cost-effectiveness of adalimumab for the maintenance of remission in patients with Crohn's disease.

OBJECTIVE Adalimumab is a fully human, monoclonal antibody clinically effective for the treatment of active Crohn's disease. The cost-effectiveness of adalimumab versus conventional, nonbiologic pharmacotherapies is unknown. This study evaluated the cost-effectiveness of adalimumab versus conventional, nonbiologic pharmacotherapies in the maintenance of Crohn's disease. METHODS Trial data from two randomized controlled studies [Crohn's Trial of the Fully Human Antibody Adalimumab for Remission Maintenance (CHARM) and CLinical Assessment of Adalimumab Safety and Efficacy Studied as Induction Therapy in Crohn's Disease (CLASSIC I)] were analyzed within a cost-utility framework using a 1-year horizon from the perspective of the National Health Service (UK). The treatment efficacy and use for the adalimumab arm were based on observations from CHARM. A regression model used data from CLASSIC I to predict efficacy in patients who received nonbiologic pharmacotherapy. Unit costs of drugs, hospitalization, and other medical resources were derived from the literature. Primary standard gamble-calculated data were used to derive health-utility estimates. RESULTS Compared with conventional, nonbiologic pharmacotherapy, adalimumab seemed to be cost-effective for the treatment of patients with severe disease and moderate-to-severe disease. The 56-week incremental cost-effectiveness ratio was 16 064 UK pounds/quality-adjusted life-year and 33 731 UK pounds/quality-adjusted life-year for severe and moderate-to-severe groups, respectively. Sensitivity analyses showed that the findings were robust. In the treatment of patients over their lifetimes, the incremental cost-effectiveness ratio was 6550 UK pounds/quality-adjusted life-year and 17 873 UK pounds/quality-adjusted life-year for patients with severe Crohn's disease and those with moderate-to-severe Crohn's disease, respectively. CONCLUSION Adalimumab maintenance therapy seems to be cost-effective versus conventional, nonbiologic therapies for the maintenance of remission in patients with active Crohn's disease.