Cost-Effectiveness Analysis of Crohn’s Disease Treatment with Vedolizumab and Ustekinumab After Failure of Tumor Necrosis Factor-α Antagonist

Przemysław Holko (), Paweł Kawalec () and Andrzej Pilc ()
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Przemysław Holko: Jagiellonian University Medical College
Paweł Kawalec: Jagiellonian University Medical College
Andrzej Pilc: Jagiellonian University Medical College

PharmacoEconomics, 2018, vol. 36, issue 7, No 10, 853-865

Abstract: Abstract Objective The aim was to evaluate the cost-effectiveness of Crohn’s disease (CD) treatment with vedolizumab and ustekinumab after failure of therapy with tumor necrosis factor-α antagonists (anti-TNFs). Methods The Markov model incorporated the lifetime horizon, synthesis-based estimates of biologics’ efficacy in relation to anti-TNF exposure, and administration of biologics reflecting clinical practice (e.g., sequence of biologics, retreatment, 12-month treatment). The utilities, non-medical costs and indirect costs were derived from a study of 200 adult patients with CD, while the healthcare costs were from a study of 1393 adults with CD who used biologics in Poland. The quality-adjusted life years (QALYs) and costs (the societal perspective) were discounted with the annual rates of 3.5 and 5%, respectively. Results The addition of vedolizumab (ustekinumab) to the sequence of available anti-TNFs (after first-line infliximab or after second-line adalimumab) led to a gain of 0.364 (0.349) QALYs at an additional cost of €5600.24 (€6593.82). The incremental cost-effectiveness ratios (ICERs) were €15,369 [95% confidence interval (CI) 7496–61,354] and €18,878 (95% CI 9213–85,045) per QALY gained with vedolizumab and ustekinumab, respectively. Sensitivity analyses revealed a high impact on the ICERs of the relapse rate after discontinuation of biologic treatment. The highest value of vedolizumab/ustekinumab was estimated after the failure of therapies with both anti-TNFs. Conclusions CD treatment with ustekinumab or vedolizumab after failure of anti-TNF therapy appears to be cost-effective at a threshold of €31,500. The replacement of the second-line anti-TNF with ustekinumab/vedolizumab and the course of the disease after discontinuation of biologics are influential drivers of the cost-effectiveness.

Date: 2018
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DOI: 10.1007/s40273-018-0653-2

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