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Introduction: Infliximab (IFX) is a standard, salvage therapy for refractory acute severe ulcerative colitis (ASUC). Remicade™ is the originator IFX. Its biosimilar Renflexis™ offers a reduced cost structure. We performed a cost-minimization analysis to compare costs with Remicade and Renflexis for inpatient treatment of ASUC.  Methods: Retrospective clinical and financial data was obtained from 34 patients with refractory ASUC who received Renflexis (n=17) or Remicade (n=17) between 2019-2021. Clinical data included admission and discharge lab values.  Financial data included a decision support drug cost (DSDC), constituting the total cost associated with inpatient infliximab administration, and total inpatient cost of care. Results: No differences were found in baseline or discharge clinical parameters. Median unadjusted ratio of DSDC to total inpatient cost of care was 0.387 vs. 0.241 in the Remicade vs. Renflexis groups (p=0.0025), respectively, representing an absolute difference of ~14%. Median adjusted rDSDC was 0.04 vs. 0.024 in the Remicade vs. Renflexis groups, respectively, representing a relative cost reduction of ~40% (p = 0.0001) Discussion: The unadjusted absolute cost reduction and adjusted relative cost reduction were respectively 14% and 40% in the Renflexis group as compared to Remicade. Our calculation included median decision support drug cost as a percentage of the total inpatient cost of care, controlling for infliximab dose and length of stay. This reduced cost structure promotes use of Renflexis for ASUC inpatients and may reduce costs for patients and hospitals.

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