CADTH recommends that Skyrizi be reimbursed by public drug plans for the treatment of moderately to severely active Crohn disease (CD) if certain conditions are met.
WHICH PATIENTS ARE ELIGIBLE FOR COVERAGE?: Skyrizi should only be covered to treat adult patients with moderately to severely active CD who do not respond to, stop responding to, or who cannot tolerate conventional or biologic therapies.
WHAT ARE THE CONDITIONS FOR REIMBURSEMENT?: Skyrizi should only be reimbursed if prescribed by a physician experienced in the diagnosis and management of CD, if it is not used in combination with other biologics, and if the cost of Skyrizi is reduced so that it does not cost the drug programs more than the least costly biologic therapy. Patients must respond to treatment in the first 12 weeks of starting Skyrizi to continue receiving the drug.
WHY DID CADTH MAKE THIS RECOMMENDATION?: Three clinical trials in patients with moderately to severely active CD who had inadequate response or were intolerant to prior conventional or biologic therapies were assessed in this review. In all of these trials, patients treated with Skyrizi showed an improved clinical remission and endoscopic response compared with patients wo were treated with placebo. Based on the evidence, Skyrizi may meet some of the needs that were identified as important to patients with CD, such as improving symptoms and health-related quality of life. Based on CADTH’s assessment of the health economic evidence, Skyrizi does not represent good value to the health care system at the public list price. The committee determined that there is not enough evidence to justify a greater cost for Skyrizi compared with other biologic therapies reimbursed for the treatment of adult patients with moderately to severely active CD. Based on public list prices, Skyrizi is estimated to cost the public drug plans approximately $56 million over the next 3 years.
WHAT IS CD?: CD is a chronic form of inflammatory bowel disease that can affect any part of the gastrointestinal tract, but commonly affects the small intestine, colon, and rectum. For many patients with CD, symptoms are chronic and sporadic, and disease severity can vary widely over time. It is estimated that CD affects more than 135,000 people in Canada.
Patients with CD expressed a need for effective treatments that reduce symptoms, achieve sustained remission or response, reduce corticosteroid use, and improve quality of life.
HOW MUCH DOES SKYRIZI COST?: Treatment with Skyrizi is expected to cost approximately $36,745 per patient in the first year and $29,855 per patient in subsequent years.
