Estimation of induction and maintenance costs of Infliximab, Adalimumab and Certolizumab Pegol in managing Crohnʼs Disease
Bibliographic record
Abstract
To estimate the induction and maintenance costs of infliximab, adalimumab and certolizumab pegol for a patient with Crohn's disease weighing 65 kg and to conduct a cohort budget analysis for tumor necrosis factor (TNF)-alpha blockers in managing Crohn's disease. A simple cos tanalysis was conducted using recommended induction and main-tenance dosing regimens for each agent over a 2-year time horizon. Average wholesale prices (AWP) of $754.50 for infliximab 100 mg, $865.58 for adalimumab 40 mg, and $822.30 for certolizumab pegol 200 mg were used in the estimations. It was assumed that the response and remission rate were the same for each agent at 60% and 40%, respectively. Maintenance therapy wasfollowed if a response to initial therapy was observed and continued in Year 2 for remitters. Per patient drug acquisition costs were estimated based on the AWP and recommended regimen of each agent. Cost for each infusion was assumed to be $50. A cohort analysis was performed for a healthcare plan of 5,000,000 members with prevalence and incidence rates of Crohn's disease of 162 per 100,000 and 9.6 per 100,000, respectively. It was assumed that 20% and 25% of the patient population received therapy with a TNF-alpha blocker in Year 1 and Year 2, respectively. The estimated induction cost was approximately $9504, $5193, and $4934 per patient for infliximab, adalimumab, and certolizumab pegol, respectively. With maintenance therapy, the 2-year expected total cost was approximately $47,520, $48,472, and $44,044 for infliximab, adalimumab, and certolizumab pegol, respectively. In the cohort analysis, with uptakes of 60%, 30%, and 10% in Year 1, and 50%, 30%, and 20% in Year 2 for infliximab, adalimumab, and certolizumab pegol, respectively, a total budget of $76,766,506 was estimated. In a scenario without access to certolizumab pegol, the estimated total budget was $78,307,778. This study suggests that, based on the standard regimens for each of the TNF-alpha blockers for Crohn's disease, certolizumab pegol therapy may be less costly than infliximab or adalimumab. However, these estimates are likely highly sensitive to the rates and costs of dose intensification, which were not taken into account in the model.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.008 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".