title: Cost per responder associated with biologic therapies for Crohn's disease, psoriasis, and rheumatoid arthritis.
abstract: BACKGROUND
  Biologic therapies have demonstrated efficacy and safety in several chronic systemic disorders. The authors indirectly compared response rates and costs per responder associated with biologic treatments for moderate-to-severe Crohn's disease (CD), psoriasis (Ps), and/or rheumatoid arthritis (RA).
  
  
  METHODS
  A systematic literature search was performed to identify phase 3 randomized controlled trials of biologics for CD (adalimumab, infliximab), Ps (adalimumab, etanercept, infliximab, ustekinumab 45 mg, ustekinumab 90 mg), or methotrexate-refractory RA (abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab, rituximab, tocilizumab). Food and Drug Administration-approved dosing schedules were evaluated. Published response rates were extracted, with response defined in CD, Ps, and RA as: ≥70-point reduction in CD Activity Index at 12 months; ≥75% improvement in Psoriasis Area and Severity Index at 3 months; and ≥50% improvement in American College of Rheumatology component scores at 6 months. Within each indication, mixed-treatment comparison meta-analyses were conducted to derive pooled estimates and 95% CIs of response rate difference versus placebo for each biologic, adjusting for cross-trial variation in control-arm response rates. Cost per responder was estimated for each biologic as projected per patient drug costs (2011 US$) divided by response rate difference.
  
  
  RESULTS
  Altogether, 23 publications were selected. In CD, 12-month cost per responder was estimated at $116,291 (95% CI $71,637-208,348) for adalimumab and $125,169 (95% CI $60,532-267,101) for infliximab. Among biologics approved in Ps, 3-month cost per responder was lowest for adalimumab ($9,756; 95% CI $8,668-11,131), infliximab ($12,828; 95% CI $11,772-13,922), and ustekinumab 45 mg ($13,821; 95% CI $12,599-15,167). In RA, biologics with the lowest 6-month cost per responder were adalimumab ($27,853; 95% CI $19,284-40,270), etanercept ($29,140; 95% CI $14,170-61,030), and tocilizumab ($31,363; 95% CI $14,713-64,232).
  
  
  CONCLUSIONS
  Meta-analyses of clinical trials found considerable variation in cost-effectiveness of biologic therapies for CD, Ps, and RA. These results may help determine biologic utilization in these chronic diseases.
authors: Division of Pharmacy Practice and Administration, The University of Missouri - Kansas City School of Pharmacy, 2464 Charlotte Street, Kansas City, MO 64108, USA. liuyif@umkc.edu
authors: Yifei
authors: Y
authors: Liu
authors: Eric Q
authors: EQ
authors: Wu
authors: Arielle G
authors: AG
authors: Bensimon
authors: Chun-Po Steve
authors: CP
authors: Fan
authors: Yanjun
authors: Y
authors: Bao
authors: Arijit
authors: A
authors: Ganguli
authors: Mei
authors: M
authors: Yang
authors: Mary
authors: M
authors: Cifaldi
authors: Parvez
authors: P
authors: Mulani
mesh_terms: D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000191:economics*; D001688:Biological Products / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003424:Crohn Disease / Q000188:drug therapy / Q000191:economics*; D016527:Drug Costs / Q000706:statistics & numerical data; D006801:Humans; D011565:Psoriasis / Q000188:drug therapy / Q000191:economics*; D016032:Randomized Controlled Trials as Topic
chemical_list: D018501:Antirheumatic Agents; D001688:Biological Products