Background: UK National Institute for Health and Care Excellence guidance states that if more than one biologic therapy option is available for patients with IBD the least expensive option should be used. However, limited economic data are available to inform these decisions.
Methods: Service evaluations (SE) were carried out in 2 UK hospitals between Feb and Sept 2016. The primary objective was to describe the overall cost of the first year of biologic therapy for patients with IBD treated with intravenous (infliximab [IFX]) or subcutaneous (adalimumab [ADA]) 1st-line anti-TNF therapy. SEs comprised a prospective time and motion evaluation of patient visits for anti-TNF treatment and a retrospective chart review of the resource utilisation associated with the first year of 1st-line anti-TNF-treatment in consenting patients with IBD treated with ADA or IFX for ≥12 months. Times for activities are reported as hh:mm:ss.
Results: For the time and motion study, 10 separate anti-TNF administration visits were observed for patients treated with ADA and IFX at each centre. The total time for all 10 administration visits in Centre 1 was 01:07:04 for ADA and 14:17:53 for IFX and in Centre 2 was 09:56:55 for ADA and 18:00:33 for IFX (see Table 1 for a breakdown of timings). The patient-reported time off work for anti-TNF administration visits was highest for patients treated with IFX at each centre (mean [SD] Centre 1: ADA 1.4 [1.5] hours/visit [n=9], IFX 3.3 [2.7] hours/visit [n=9]; Centre 2: ADA 3.7 [2.8] hours/visit [n=9], IFX 5.4 [3.1] hours/visit [n=8]). The total resource utilisation and related costs associated with the 1st year of anti-TNF therapy in Centre 1 (ADA n=16, IFX n=19) and Centre 2 (ADA n=19, IFX n=20) are summarised in Table 2. The drug cost/patient/year was similar for each anti-TNF at each centre (mean [SD] Centre 1: ADA £10,740.27 [445.43]/patient/year [n=16], IFX £11,319.08 [2,873.64]/patient/year [n=19]; Centre 2 ADA £11,398.22 [2,403.31]/patient/year [n=19], IFX £10,839.00 [ 2,626.54]/patient/year [n=20]).
Conclusions: The use of NHS resources associated with the use of ADA and IFX varies across the studied centres. The total cost/patient/year ranged between £363–£580 for ADA and £1563–£ 2067 for IFX. The total administration time of the anti-TNF ranged between 1 and 10h for ADA and 14 and 18h for IFX.