Rectification of miscalculation of adalimumab costs

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Department of Surgery, Academic Medical Center,. Meibergdreef 9, 1105 AZ, Amsterdam,. The Netherlands. Rectification of miscalculation of adalimumab costs.
Letter to the Editor Editorial For reprint orders, please contact [email protected]

Rectification of miscalculation of adalimumab costs Expert Review of Gastroenterology & Hepatology Downloaded from informahealthcare.com by 117.174.25.166 on 05/20/14 For personal use only.

Expert Rev. Gastroenterol. Hepatol. 5(4), 437–438 (2011)

Emma J Eshuis Author for correspondence: Department of Gastroenterology and Hepatology, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands and Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands Tel.: +31 205 664 580 Fax: +31 205 669 285 [email protected]

Pieter CF Stokkers Department of Gastroenterology and Hepatology, St Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands

Willem A Bemelman Department of Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

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Response to: Eshuis EJ, Stokkers PC, Bemelman WA. Decision-making in ileocecal Crohn’s disease management: surgery versus pharmacotherapy. Expert Rev. Gastroenterol. Hepatol. 4(2), 181–189 (2010).

In the April 2010 issue of Expert Review of Gastroenterology and Hepatology, we published an article regarding the decisionmaking in the management of Crohn’s disease (CD) in the terminal ileum, with the question whether to treat medically or surgically. One of the parameters we used for this decision-making process was the costs of the various medical and surgical treatment options. Our conclusion was that surgical therapy is much less expensive compared with biological therapy. Furthermore, although this was not the subject of this article, we argued that adalimumab (Humira) therapy may be more expensive compared with infliximab (Remicade®) therapy when the costs are calculated based on the prices of both drugs in The Netherlands. Recently, however, we were approached by Abbott, the manufacturer of adalimumab, and they made us aware of a miscalculation with regard to the costs of their product. With this letter we would like to rectify this and apologize for our mistake. With regard to those costs, the surgical treatment options costs were derived from a published randomized trial comparing laparoscopic to open ileocolic resection [1] . The costs of regular medical treatment options for moderate-to-severe CD, being infliximab or adalimumab, were calculated from data derived from the website of the Dutch pharmacotherapeutical compass [101] . For adalimumab, we mistakenly based our initial cost calculation on a unit price of €1084 per 40  mg. This was incorrect; on the website the costs were presented as costs per month of treatment.

10.1586/EGH.11.15

Adalimumab is administered every other week, meaning that per month, two doses of 40 mg are administered. This means that the calculated costs were twice as high as the actual costs. With this rectification letter we hope to set this mistake right by presenting the correct current costs. Cost of adalimumab

The first two administrations of adalimumab are ‘loading’ doses of 160 mg (four injections) at week 0 and 80 mg (two injections) at week 2. After this, 40 mg (one injection) of adalimumab is administered once every 2 weeks. The price per injection is €496.94. This means that in the first year, costs mount up to €14,908.20. The cost of every following year, without necessity of loading doses, is €12,920.44. Only in the case of dose intensification, which means that adalimumab is administered every week, do the costs double. Cost of infliximab

Infliximab is supplied in ampoules of 100  mg and should be administered as a dosage of 5 mg/kg of bodyweight during daycare admission. Therefore, one ampoule represents 20 kg of bodyweight. In most cases, four ampoules are required (for patients weighing 60–80 kg). One ampoule costs €591.88; therefore, one infusion for a patient weighing 60–80 kg costs €2367.52. In the first year of therapy, three loading doses are administered in weeks 0, 2 and 6; thereafter infliximab is administered

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Letter to the Editor

Eshuis, Stokkers & Bemelman

n ic tio ‡ op ec n sc es io ct ro c r se pa oli e r La oc lic ile o g rs oc m a ile 40 ye n 0– ng pe i –8 O w 60 llo (1 † fo – ar k) A ye e AD irst r we f – he A y ot AD er † ev g m s 40 ar – ye A g AD in w llo fo – ar )† X IF ye ns st io fir us † f – n X ti on si IF igh fu (e in e on

X IF





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Cost (€)

every 8 weeks. This means that in the 30,000 first year, eight infusions are administered, costing €18,940.16. 25,000 The costs of every subsequent year, with20,000 out the loading doses, are €16,572.64. When patients are treated for shorter intervals or 15,000 double doses, the cost increases equivalently. 10,000 It is important to realize that this cost calculation of infliximab is based only on 5000 the cost of the drug itself, separate from 0 daycare costs at the hospital, estimated at €500 per infusion. These estimates are based on prices of the drugs in The Netherlands and rough estimates of dose and dose intervals would imply that adalimumab is less expensive compared with infliximab (also see rectified Figure 1). We would like to stress that these calculations cannot be used as a cost– Figure 1. Costs of anti-TNF therapy and ileocolic resection. IFX costs were effectiveness analysis of both drugs. The calculated for a person weighing 60–80 kg. important message of our paper remains † Data taken from [101] . unaffected: anti-TNF therapies are very ‡ Data taken from [1] . expensive treatments compared with ileo­ ADA: Adalimumab; IFX: Infliximab. colic resection. Since both ileocolic resection and anti-TNF treatment are reasonably safe strategies for the Financial & competing interests disclosure treatment of CD in the ileocecal region, clinical trials comparing The authors have no relevant affiliations or financial involvement with any both strategies at the level of cost–effectiveness, safety and quality organization or entity with a financial interest in or financial conflict with of life are eagerly awaited [2] . the subject matter or materials discussed in the manuscript. This includes Disclaimer

This work is the opinion of the author and does not represent the views of Expert Reviews Ltd or its employees.

References 1

Maartense S, Dunker MS, Slors JF et al. Laparoscopic-assisted versus open ileocolic resection for Crohn’s disease: a randomized trial. Ann. Surg. 243, 143–149 (2006).

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2

employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. No writing assistance was utilized in the production of this manuscript.

Eshuis EJ, Bemelman WA, van Bodegraven AA et al. Laparoscopic ileocolic resection versus infliximab treatment of distal ileitis in Crohn’s disease: a randomized multicenter trial (LIR!C-trial). BMC Surg. 8, 15 (2008).

Website 101

Farmacotherapeutisch Kompas www.fk.cvz.nl (Accessed 3 December 2010)