{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T21:23:19Z","timestamp":1791235399914,"version":"4.1.0"},"reference-count":59,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2020,2,11]],"date-time":"2020-02-11T00:00:00Z","timestamp":1581379200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Hospital for Sick Children\u2019s Research Training Competition (Restracomp) Award"},{"name":"Ontario Graduate Scholarship Program"},{"name":"Institute of Health Policy, Management and Evaluation"},{"name":"CIHR Travel Award\u2014Institute Community Support"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,2,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background and Aims<\/jats:title>\n                  <jats:p>Lower-cost biosimilar infliximab may address affordability concerns in the treatment of adults with Crohn\u2019s disease (CD), however, evidence regarding the cost-effectiveness of switching from reference to biosimilar is warranted. The aim of this research was to assess the incremental cost of switching from treatment with reference infliximab to biosimilar compared with maintaining reference infliximab in adults with CD per quality-adjusted life year (QALY) gained.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A probabilistic cohort Markov model with 8-week cycle lengths was constructed to estimate the incremental costs and effects of switching over a 5-year time horizon from a public payer perspective. Base-case clinical inputs were obtained from NOR-SWITCH subgroup analyses and other published trials. Costs were obtained from Canadian sources. A total of 10,000 simulations were run. Sensitivity analysis was used to test the robustness of the results to variations in uncertain parameters.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Switching to biosimilar infliximab was less costly but also less effective with incremental savings of $46,194 (95% confidence interval [CI]: $42,420, $50,455) and a loss in QALYs of \u22120.13 (95% CI: \u22120.16, \u22120.07). Eighty-three per cent of the simulations demonstrated incremental cost savings and an incremental loss of effectiveness. The model was sensitive to differences in rates of disease worsening between reference and biosimilar infliximab.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>While biosimilar infliximab is associated with incremental savings for patients on maintenance therapy who are switched from reference infliximab, funding decision makers must decide whether a small loss of effectiveness is justified. Further evidence will help to inform reimbursement policy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jcag\/gwz045","type":"journal-article","created":{"date-parts":[[2019,12,13]],"date-time":"2019-12-13T20:09:46Z","timestamp":1576267786000},"page":"48-48","source":"Crossref","is-referenced-by-count":8,"title":["A Cost-Utility Analysis of Switching from Reference to Biosimilar Infliximab Compared to Maintaining Reference Infliximab in Adult Patients with Crohn\u2019s Disease"],"prefix":"10.1093","volume":"4","author":[{"given":"Avery","family":"Hughes","sequence":"first","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John K","family":"Marshall","sequence":"additional","affiliation":[{"name":"Department of Medicine and Farncombe Family Digestive Health Research Institute, McMaster University, Hamilton, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Myla E","family":"Moretti","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"Ontario Child Health Support Unit and the Clinical Trials Unit, The Hospital for Sick Children, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wendy J","family":"Ungar","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada"},{"name":"Program of Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,2,11]]},"reference":[{"key":"2021022211284456500_CIT0001","volume-title":"The Biologics Revolution in the Production of Drugs","author":"Lybecker","year":"2016"},{"key":"2021022211284456500_CIT0002","author":"National Prescription Drug Utilization Information System."},{"key":"2021022211284456500_CIT0003","volume-title":"IMS Brogan Private Drug Plan Drug Cost Forecast Commissioned by Rx&D","author":"IMS Brogan."},{"key":"2021022211284456500_CIT0004","volume-title":"Prescribed Drug Spending in Canada, 2017","author":"Canadian Institute for Health Information.","year":"2017"},{"key":"2021022211284456500_CIT0005","volume-title":"Advancing Biosimilar Sustainability in Europe: A Multi-Stakeholder Assessment","author":"IQVIA Institute for Human Data Science."},{"issue":"4","key":"2021022211284456500_CIT0006","first-page":"3","article-title":"Biosimilar cost savings in the United States: Initial experience and future potential","volume":"7","author":"Mulcahy","year":"2018","journal-title":"Rand Health Q"},{"key":"2021022211284456500_CIT0007","author":"Crohn\u2019s and Colitis Foundation of Canada.","year":"2012"},{"issue":"15","key":"2021022211284456500_CIT0008","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1056\/NEJM199710093371502","article-title":"A short-term study of chimeric monoclonal antibody cA2 to tumor necrosis factor alpha for Crohn\u2019s disease. 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