Grant: Travel Awards - Institute Community Support

Purpose: Biologics, such as infliximab, are an important treatment option for patients with moderate-to-severe Crohn's Disease (CD), but their costs are often high. The introduction of lower-cost biosimilars offers a unique opportunity to address sustainability concerns.The purpose of this analysis is to assess the incremental cost of maintenance treatment for adults with CD who have been switched from reference infliximab to biosimilar infliximab compared with those who have been maintained on reference infliximab per quality adjusted life year (QALY) gained from the healthcare system perspective. Method: A probabilistic Markov model with eight-week cycle lengths was constructed to estimate the incremental costs and effects of switching to biosimilar infliximab over a five-year time horizon. Clinical inputs were obtained from NOR-SWITCH and other pivotal trials. Costs were obtained from Canadian sources. Result: In the reference case total costs for switching to biosimilar were $50,191 (standard deviation [SD]: $4,771) and 3.06 (SD: 0.38) QALYs. Costs for maintaining treatment with the reference were $96,385 (SD: $6,834) and 3.19 (SD: 0.35) QALYs. While the intervention was associated with incremental savings of $46,194 (95% Confidence Interval [CI]: $42,420 - $50,455) it was also associated with a loss in QALYs of -0.13 (95% CI: -0.16 - -0.07). 83% of the 10,000 simulations were in the south-west quadrant. Sensitivity analyses showed the model was sensitive to probability of relapse and infliximab drug cost. Conclusion: Biosimilar infliximab is associated with incremental savings when CD patients on maintenance therapy are switched from reference infliximab. This is an important finding with regard to sustainability however, decision makers must also account for an incremental loss of effectiveness with biosimilars. Further evidence regarding interchangeability will be integral for decision makers to develop effective reimbursement policies for biosimilars.