The Institute for Clinical and Economic Review (ICER) conducted a systematic literature review and cost-effectiveness analysis to evaluate the health and economic outcomes of these TIMs for UC. The clinical evidence shows that TIMs are superior to conventional therapy alone. Results supported by the single head-to-head trial and indirect treatment comparison suggests that vedolizumab had greater rates of clinical response and remission than adalimumab, but distinguishing further between the effectiveness of different agents is not possible. At the current pricing, most TIMs were estimated to have incremental cost-effectiveness ratios far higher than traditional thresholds. Notably, infliximab and infliximab biosimilars have much lower average net prices than other TIMs and therefore had markedly better cost-effectiveness ratios, which points to the significant potential for improved value with biosimilar treatment alternatives. Despite this sign of promise, the overall cost of TIMs for UC is too high, even given their substantial clinical benefits, to align reasonably with those benefits. As a result, given that there are no clinical markers suggesting which patients will benefit most from particular TIMs, it is not unreasonable for payers to use prior authorization and judiciously designed step therapy to help manage utilization and seek equivalent outcomes at lower costs.
