COST-MINIMIZATION ANALYSIS AND TOTAL COST ANALYSIS FOR A WEIGHT RANGE IN
CROHN’S DISEASE TREATMENT WITH ANTI-TNF BIOLOGICS UNDER BRAZILIAN PRIVATE
HEALTH CARE SYSTEM PERSPECTIVE
Authors: Fabiana Gatti de Menezes1, Pharm, Msc, PhD, Vivian Chibana1, Business Administration.
Affiliations: 1 HEOR, AbbVie Brazil, São Paulo, Brazil.
Presented at ISPOR 18th Annual European Congress, 7-11 November, 2015, MiCo – Milano Congressi in Milan, Italy.
ABSTRACT
OBJECTIVE: The aim of this study was to describe the
total treatment costs related to Crohn’s Disease
treatment with biologics and to evaluate these costs
based on the most prevalent weight range.
METHODS: A cost-minimization analysis was
performed among adalimumab-subcutaneous (ADA)
and infliximab-intravenous (IFX) to compare the total
treatment costs in Crohn's disease according to the
Brazilian Private HealthCare System perspective.
Total treatment cost was calculated based on the
dose per application, number of vial/syringe, cost of
application and median and range of weight. These
inputs were based on scientific literature. Yearly
treatment cost was calculated for patients with a
median of 68kg, according to doses defined in
product labels. A cost analysis for a weight range was
performed. Drug prices were based on Factory Prices
plus 18% taxes (CMED source). An univariate analysis
was performed to determine the impact on results.
RESULTS: The median patient weight used in this
analysis was 68±4,08kg (Weight range: 64 to 72kg normal distribution). For IFX the Medication Cost was
R$92.478,12, Application Cost was R$2.360,33 and
the Total Treatment Cost was R$94.838,45. For ADA
the Medication Cost was R$85.807,15, Application
Cost was R$3.788,98 and the Total Treatment Cost
was R$89.596,13. Comparing the scenario with IFX
and ADA, the treatment with ADA presented a
savings of R$5.242,32 per patient/year. The weight
interval cost analysis presented a savings for ADA of
R$5.242,32 per patient/year in a range of 64 to 72kg.
In sensitivity analysis ADA presented economic
savings in most scenarios, the variation of IFX vial
and ADA syringe costs are important factors that
could modify the sensitivity analysis.
Conclusions: The treatment of Crohn’s disease with
ADA compared to IFX presented an economic savings
for nearly 68% of patients with Crohn’s Disease in the
Brazilian Private HealthCare System.
INTRODUCTION
Even though the high cost of medication in Chron
Disease (CD), monoclonal antibodies represent a
major advance in therapy with significant decrease
hospitalizations, surgery and laboratory tests
numbers. Also, they have a higher effectiveness
compared to conventional therapy 1, 2. The last
publication related to cost minimization analysis of
adalimumab (ADA) and infliximab (IFX) – 2009 - was
based on weight range and only medication costs3.
METHODS
RESULTS
The median patient weight used in this analysis was
68±4,08kg (Weight range: 64 to 72kg - normal
distribution) with a disease length of 72 months9.
Study limitations: we assume the same model of
reimbursement between HMOs for all the market;
the population growth rate that was used had base
just in the population that use the Private Health
Care System; variation in costs of infusion and
application.
In deterministic sensitivity analysis cost per vial of IFX, cost per syringe
of ADA and market-share of patients were the most important variables
that impacted results. A majority of DSA scenarios indicated that
treatment with ADA provides cost savings.
1.853
METHODS
A cost-minimization analysis was performed among
Adalimumab - subcutaneous (ADA) and Infliximabintravenous (IFX) to compare the total treatment
costs in Crohn's disease according to the Brazilian
Private HealthCare System perspective. Drug prices
were based on Factory Prices plus 18% taxes (CMED
source) – Table 1. Total treatment cost was
calculated based on the dose per application,
number of vial/syringe, cost of application and
median and range of weight (Table 2). Yearly
treatment cost was calculated for patients with a
median of 68kg, according to doses defined in
product labels. A cost analysis for a weight range
was performed. A univariate analysis was performed
to determine the impact on results.
2.004
1.927
2.084
2.167
Table 1: Medication cost description.
Drug name and formulation Factory price + taxes
18% (R$)
INFLIXIMAB - Vial
ADALIMUMAB - 2 Syringes
(PEN)
3302,79
ADALIMUMAB - 1 Syringe (PEN)
3300,27
Year 1
Year 2
Year 3
Year 4
Year 5
Figure 2: Costs according the lenght of disease (R$).
68% of
patients
6600,55
http://portal.anvisa.gov.br/wps/wcm/connect/cc2b47004a09f81d
b4a3bcbb505253ad/LISTA+CONFORMIDADE_2015-0928.pdf?MOD=AJPERES
Table 2: Medication costs calculation description.
Dose per infusion and
subcutaneous injection
respectively (mg/Kg or
mg)4
mg per vial and syringe
Number of vials and
syringes/injection
Number of infusions and
Number of subcutaneous
injections/Year4
Number of vials /year
Number of syringes/year
R$/ vial and ampule
(Factory Price)5
Medication cost/year
Patient Mediam Weight
(kg)6
Cost/infusion and
subcutaneous injection7,8
Total cost/injection
Final treatment cost Fixed
Total dose (mg)
IFX
ADA
5
40
100
4
40
1
7
26
Figure 3: Sensitivity Analysis
Vial Cost IFX
28
26
R$ 3.302,79
R$ 3.300,28
R$ 92.478,12
68
R$ 85.807,15
-
R$ 337,19
R$ 145,73
R$ 2.360,33
R$ 94.838,45
R$ 3.788,98
R$ 89.596,13
340
40
OBJECTIVE
This study aim study was to describe the total
treatment costs related to Crohn’s Disease
treatment with biologics and to evaluate these costs
based on the most prevalent weight range.
5 year time period.
Figure 1: Eligible Patients
RESULTS
The median patient weight used in this analysis was
68±4,08kg (Weight range: 64 to 72kg - normal
distribution). For IFX the Medication Cost was
R$92.478,12, Application Cost was R$2.360,33 and
the Total Treatment Cost was R$94.838,45. For ADA
the Medication Cost was R$85.807,15, Application
Cost was R$3.788,98 and the Total Treatment Cost
was R$89.596,13 – Table 2. Figure 2 present the
treatment costs related to the length of disease, with
ADA the costs were stable and with IFX they
progressively grow. Comparing the scenario with IFX
and ADA, the treatment with ADA presented savings
of R$5.242,32 per patient/year – Figure 1. The weight
interval cost analysis presented savings of
R$5.242,32per patient/year for ADA in a range of 64
to 72kg. In sensitivity analysis ADA presented
economic savings in most scenarios, the variation of
IFX vial cost and ADA syringe costs are important
factors that could modify the model results.
Pen Cost ADA
SC Application
Cost ADA
Infusion Cost IFX
Minimum
case
Vial Cost IFX
Pen Cost ADA
Injection Cost ADA
Infusional Cost IFX
R$ 618,41
R$ 9.532,68
R$ 5.810,67
R$ 4.888,27
Maximum
case
-R$ 4.005,49
R$ 13.823,04
R$ 4.673,97
R$ 5.596,37
CONCLUSION
The treatment of CD with ADA compared to IFX presented economic
savings for nearly 68% of patients with CD in the Brazilian Private
HealthCare System.
REFERENCES
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the ACCENT I randomised trial. Lancet 2002;359:1541-1549.2.Colombel JF, Sandborn WJ, Rutgeerts P, Enns R, Hanauer SB,
Panaccione R, et al. Adalimumab for maintenance of clinical response and remission in patients with Crohn's disease: the
CHARM trial. Gastroenterology 2007;132(10):52-65.3.Kotze Paulo Gustavo, Albuquerque Idblan Carvalho de, Moraes Antônio
Carlos, Vieira Andrea, Souza Fernando de. Análise de custo-minimização entre o Infliximabe (IFX) e o Adalimumabe (ADA) no
tratamento da doença de Crohn (DC). Rev bras. colo-proctol. [Internet]. 2009 June [cited 2015 Oct 19] ; 29( 2 ): 158-168. 4.
Label. 5. CMED (2014). 6. Andreassen H, Hylander E, Rix M. Gender, age, and body weight are the major predictive factors for
bone mineral density in Crohn's disease: a case-control cross-sectional study of 113 patients. Am J Gastroenterol. 1999
Mar;94(3):824-8. 7. Vitale V, Pinto Neto JV, Asano E. Total Treatment Costs Analysis Between Subcutaneous And Intravenous
Bortezomib Under Brazilian Private Health Care System Perspective. Poster Presented At ISPOR 19th Annual International
Meeting, May 31 - June 4; Montreal, Canada. 8. Vitale V, Asano E, Pereira ML. Budget impact analysis of abiraterone acetate in
metastatic castration resistant prostate cancer patients previously treated with docetaxel under Brazilian Private Health Care
System Perspective. Value in Health, 11/2013, 16(7): A665. 9.Andreassen H, Hylander E, Rix M. Gender, age, and body weight
are the major predictive factors for bone mineral density in Crohn's disease: a case-control cross-sectional study of 113 patients.
Am J Gastroenterol. 1999 Mar;94(3):824-8. e Colocar Gráfico da Curva Normal.
ACKNOWLEDGEMENTS
AbbVie Inc. funded the study. AbbVie was responsible for the study design, research, analysis,
data collection, interpretation of data, and writing, reviewing, and approving of the publication.
The authors would like to thank Vinicius Vitale from AbbVie for modelling support.
DISCLOSURES
The design, study conduct, and financial support for the study were provided by AbbVie. AbbVie
participated in the interpretation of data, review, and approval of the publication. Fabiana Gatti
Menezes and Vivian Chibana are employees of AbbVie and own AbbVie stock.