The efficacy and safety of ustekinumab compared with conventional and other biologic therapy were based on an indirect comparison with noted limitations and heterogeneity across studies that raise uncertainty concerning the comparative efficacy and safety of ustekinumab in both the induction and maintenance phases. Other key limitations of the economic model pertain to the utility values included and the effects of real-world evidence on transition probabilities, despite the lack of supportive data. In light of these limitations, CDR suggests that the ICUR for ustekinumab ranges from $115,474 to $189,403 per QALY when compared with conventional therapy, and from being dominant to $870,045 per QALY when compared with other biologic therapy.

At an induction dose of 6 mg/kg followed by 90 mg at week 8 and every eight weeks thereafter, the cost of ustekinumab in year 1 ($33,798) and subsequent years ($29,855) is higher than the cost of vedolizumab ($26,320 and $21,458, respectively), adalimumab ($23,099 and $20,019, respectively), and infliximab (brand: $31,602 and $25,765, respectively; biosimilar: $16,800 and $13,697 respectively). When ustekinumab is administered every 12 weeks in the maintenance phase, the costs for year 1 ($24,612) and subsequent years ($19,904) are lower than or comparable to the other biologics, with the exception of biosimilar infliximab.

If the drug costs associated with the induction dose for ustekinumab are reimbursed by the manufacturer, the ICURs for ustekinumab compared with conventional therapy and other biologic therapies tend to improve, as would be expected.