title: Costs of adalimumab versus infliximab as first-line biological therapy for luminal Crohn's disease.
abstract: OBJECTIVE
  Randomised controlled trials demonstrate that the anti-tumour necrosis factor-α (anti-TNFα) 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-TNFα 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 12weeks, 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-TNFα 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 less per patient (95% confidence interval £1816.61-£11569.29)), 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-TNFα therapy are greater, which may have implications for selection. Clinical outcomes appeared comparable, although power to detect a statistically significant difference would be limited.
authors.affiliation: Leeds Gastroenterology Institute, Leeds General Infirmary, Leeds, UK.
authors.forename: Grace K H
authors.initials: GK
authors.lastname: Choi
authors.affiliation: Leeds Gastroenterology Institute, Leeds General Infirmary, Leeds, UK.
authors.forename: Stephanie D E
authors.initials: SD
authors.lastname: Collins
authors.affiliation: Leeds Gastroenterology Institute, Leeds General Infirmary, Leeds, UK.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Greer
authors.affiliation: Leeds Gastroenterology Institute, Leeds General Infirmary, Leeds, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Warren
authors.affiliation: Leeds Gastroenterology Institute, Leeds General Infirmary, Leeds, UK.
authors.forename: Grace
authors.initials: G
authors.lastname: Dowson
authors.affiliation: Leeds Gastroenterology Institute, Leeds General Infirmary, Leeds, UK.
authors.forename: Tanya
authors.initials: T
authors.lastname: Clark
authors.affiliation: Leeds Gastroenterology Institute, Leeds General Infirmary, Leeds, UK.
authors.forename: P John
authors.initials: PJ
authors.lastname: Hamlin
authors.affiliation: Leeds Gastroenterology Institute, Leeds General Infirmary, Leeds, UK; Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK. Electronic address: alexf12399@yahoo.com.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Ford
mesh_terms: D000068879:Adalimumab; D000293:Adolescent; D000328:Adult; D000465:Algorithms; D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics* / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003424:Crohn Disease / Q000188:drug therapy / Q000191:economics*; D005260:Female; D005500:Follow-Up Studies; D005765:Gastrointestinal Agents / Q000191:economics* / Q000627:therapeutic use; D006801:Humans; D000069285:Infliximab; D008297:Male; D012074:Remission Induction
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D005765:Gastrointestinal Agents; D000069285:Infliximab; D000068879:Adalimumab
keywords: Adalimumab; Crohn's disease; Infliximab