The value of vedolizumab as rescue therapy in moderate-severe Crohn's disease patients with adalimumab non-response in the USA

Abstract

Background and aims: In May 2014, vedolizumab was approved by the Food and Drug Administration for the treatment of moderate-to-severe Crohn's disease. In clinical practice it is typically used in patients who are primary or secondary non-responders to adalimumab [Humira®]. We aim to estimate the incremental benefits and costs of using vedolizumab as rescue therapy for adalimumab non-responders. Methods: A Markov model was used to simulate the clinical course of Crohn's disease in a hypothetical cohort of 10 000 patients over a 12-month period. The treatment strategies evaluated were adalimumab only [with and without dose intensification] and adalimumab and vedolizumab [with and without adalimumab dose intensification]. The base case strategy was adalimumab only with 25% of non-responders undergoing dose intensification. Our primary outcomes were changes in costs and quality of life measures over the analytical horizon. Results: In a 1-year period, initiating vedolizumab as rescue therapy in adalimumab nonresponders reduces the average total cost per patient by 10%, and increases the average amount of time spent in remission or mild disease by up to 2 months. Conclusions: Treating on-label adalimumab non-responders with vedolizumab can, in the short term, significantly improves the quality of life of Crohn's disease patients that do not respond to adalimumab.