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Canakinumab (Ilaris) [Internet]. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016 Nov.

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Canakinumab (Ilaris) [Internet].

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APPENDIX 1COST COMPARISON

The treatment options presented in the tables below have been deemed to be appropriate by clinical experts for the treatment of patients with sJIA. Comparators may be recommended (appropriate) practice, versus actual practice. Comparators are not restricted to drugs, but may be devices or procedures. Existing product reimbursement agreements are not reflected in the table and as such may not represent the actual costs to public drug plans.

Table 5Cost Comparison Table for Systemic Juvenile Idiopathic Arthritis (Biologic Drugs)

Drug/
Comparator
StrengthDosage FormPrice ($)Recommended DoseAverage
Annual Drug
Cost ($)
Drugs indicated for the treatment of sJIA
Canakinumab
(Ilaris)
150 mgVial of powder
for sol. for SC
injection
16,000.00aBody weight > 9 kg, 4 mg/kg (max 300 mg)
every 4 weeks
37 kg or below:
208,000
38 kg or above:
416,000
Tocilizumab
(Actemra)
80 mg/4mL
200 mg/10mL
400 mg/20mL
Vials
(concentrate
sol. for IV
infusion)
180.8100
452.0300
904.0600
Patients < 30 kg: 12
mg/kg
Patients ≥ 30 kg: 8 mg/kg
every 2 weeks
12 to 29 kg:b
9,402 to 23,506
30 kg or above:b
14,103 to 28,207c
Off-label drugsd
Anakinra
(Kineret)
100 mgPrefilled syringe
for SC injection
47.5814100 mg daily17,367

IV = intravenous; SC = subcutaneous; sJIA = systemic juvenile idiopathic; sol = solution.

All prices are from the Ontario Drug Benefit Formulary and Exceptional Access Program (both accessed March 2016) unless otherwise indicated, but do not include dispensing fees.15

All vials are single-use. Wastage was assumed when calculating annual costs. The cost of intravenous infusion is not included.

a

Manufacturer’s submitted price.3

b

Tocilizumab is listed for patients 2 years or older. The average weight of 2 year olds in Canada is 12 kg, and the average weight of 17 year olds in Canada is 60 kg.16

c

The upper bound limit assumes a maximum patient weight of 60 kg; whereby, a 1 × 400 mg vial and 1 × 80 mg vial will be used.

d

Anakinra is not indicated for patients with sJIA. However, as noted by the clinical expert, it is often prescribed to patients with sJIA. Additionally, it is reimbursed for sJIA by the Ontario Drug Benefit Formulary.14

Table 6Other Potential Treatments for Systemic Juvenile Idiopathic Arthritis (TNF Inhibitors) — Not Indicated

Drug/
Comparator
StrengthDosage FormPrice ($)Recommended DoseAverage
Annual Drug
Cost ($)
Adalimumab
(Humira)
40 mg/0.8 mLVial of sterile
solution for SC
injection
740.3600Age 2 to < 4: 20 mg
every 2 weeks
Age 4 to 17: 40 mg
every 2 weeks
19,249
Abatacept
(Orencia)
250 mg/15 mLVial for IV infusion490.0470Patients < 75 kg: 10
mg/kg (Patients ≥ 75 kg
max 1,000 mg) every 4
weeksa
20 kg to 60 kg:b
6,371 to 19,112
Etanercept
(Enbrel)
50 mg/mL
25 mg/vial
Prefilled syringe
Powder for
reconstitution
395.3900
197.6350
0.8 mg/kg (max 50 mg)
per weekc
16 kg to 60 kg:d
10,277 to 20,554
Infliximab
(Remicade)
100 mg/vialInjection for IV
infusion
987.56003 mg/kg every 8 weekse33 kg or below:
6,419
34 kg to 60 kg:
12,838

IV = intravenous; SC = subcutaneous; TNF = tumour necrosis factor.

All prices are from the Ontario Drug Benefit Formulary and Exceptional Access Program (both accessed March 2016) unless otherwise indicated, but do not include dispensing fees.15

a

Patients receive doses at weeks 2 and 4 to start, and then every 4 weeks. In the first year of treatment, abatacept would cost an extra $490 to $1,470 compared with subsequent years.

b

Abatacept is listed for patients aged 6 years or older. The average weight of 6 year olds in Canada is 20 kg, and the average weight of 17 year olds in Canada is 60 kg.16

c

The 50-mg prefilled syringe should only be used for pediatric patients weighing 63 kg or more. All other patients receive the 25 mg vial of powder for reconstitution.

d

Etanercept is listed for patients aged 4 years or older. The average weight of 4 year olds in Canada is 16 kg, and the average weight of 17 year olds in Canada is 60 kg.16 For the calculation of the annual cost, it was assumed all patients received the 25 mg vial of etanercept.

e

Patients receive doses at week 0, 2, and 6 to start and then every 8 weeks thereafter. In the first year of treatment, infliximab would cost an extra $2,469 to $7,407 compared with subsequent years. Additionally, for patients who have an incomplete response, the dose of infliximab may be increased to 10 mg/kg and or/ treated every 4 weeks.

Table 7Treatments Used in Supportive Care for Systemic Juvenile Idiopathic Arthritis — not indicated

Drug/
Comparator
StrengthDosage FormPrice ($)Recommended
Dose
Average
Annual Drug
Costa ($)
Non-biologic DMARDs
Methotrexate
(generics)
2.5 mg
10 mg
10 mg/mL
25 mg/mL
Tablet

Single-use vial
0.6325
2.7000b
12.5000/2 mL
8.9200/2 mL
1 mg/kg weeklyOral: 173–842c
Injection: 650–1,114d
Corticosteroids
Prednisonee
(generics)
1 mg
5 mg
50 mg
Tablet0.1066
0.0220
0.1735
1 mg/kg weekly11–13f

DMARD = disease-modifying antirheumatic drug.

All prices are from the Ontario Drug Benefit Formulary (accessed March 2016) unless otherwise indicated and do not include dispensing fees.17

a

Based on a patient weight of 12 kg to 60 kg.

b

Saskatchewan drug benefit formulary (accessed March 2016).

c

Range is based on a 12 kg (1 × 10 mg tab + 1 × 2.5 mg tab weekly) to 60 kg (6 × 10 mg tab weekly) patient.

d

Range is based on a 12 kg (1 × 25 mg/mL vial weekly) to 60 kg (1 × 25 mg/mL vial + 1 × 10 mg/mL vial weekly). The price of vials is based on a 2 mL solution package. Wastage assumed.

e

Prednisone suspension might be used in younger patients, as noted by the CDR clinical expert.

f

Range is based on a 60 kg patient (1 × 50 mg tablet + 2 × 5 mg tablet weekly) to 12 kg patient (2 × 5 mg tablet + 2 × 1 mg tablet weekly).

Copyright © CADTH 2016.

Except where otherwise noted, this work is distributed under the terms of a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence (CC BY-NC-ND), a copy of which is available at http://creativecommons.org/licenses/by-nc-nd/4.0/

Bookshelf ID: NBK409908

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