OBJECTIVES: Patients with inflammatory bowel diseases (IBD) are commonly treated with biologic therapies such as ustekinumab and vedolizumab and usually undergo dose escalations (DE), which impacts the treatment costs of these treatments. This study aims to evaluate the treatment costs based on the real-life dosages of ustekinumab and vedolizumab administered to patients in Portugal.

METHODS: Using retrospective and longitudinal data provided by a set of 16 public hospitals, patients treated with vedolizumab and ustekinumab in gastroenterology departments were identified. Those who started maintenance treatment from January 2020 onwards and completed one year of therapy were selected. The annual maintenance dosage per patient was obtained by summing all doses consumed over a one-year period. Additionally, dose escalation prevalence and magnitude were used to quantify the equivalent patient treatment rate representing the number of patients per 100 that could have been treated with the standard dosing. The average annual treatment cost per patient was compared to the annual costs if the defined standard SmPC dosages were followed, using list prices. Finally, a sensitivity analysis on the prices of both molecules was performed to evaluate the differences in DE.

RESULTS: 39% of vedolizumab and 93% of ustekinumab patients undergo DE in their first year of maintenance. The patient equivalence is higher for ustekinumab (161) than vedolizumab (117). The real-life annual treatment cost with vedolizumab (10.215€) and ustekinumab (14.958€) increase 17% and 61%, respectively, when compared to the expected cost if the standard SmPC dose was followed. Considering real-life DE and the list prices, Vedolizumab is 32% less expensive than ustekinumab.

CONCLUSIONS: During the first year of maintenance, patients treated in Portugal with ustekinumab undergo DE more often than vedolizumab. This DE causes an unexpected increase in the annual treatment costs, with greater relevance for ustekinumab.