Cost-Effectiveness of Vedolizumab as a First-Line Advanced Therapy Versus Adalimumab Treatment Sequences for Ulcerative Colitis in Italy

Jonathan Salcedo (), Daniel Hill-McManus, Chloë Hardern, Oyin Opeifa, Raffaella Viti, Ludovica Siviero, Antonio Saverio Roscini and Gennaro Martino
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Jonathan Salcedo: Takeda Pharmaceuticals U.S.A., Inc.
Daniel Hill-McManus: Putnam Associates
Chloë Hardern: Putnam Associates
Oyin Opeifa: Putnam Associates
Raffaella Viti: Takeda Italy S.p.A.
Ludovica Siviero: Takeda Italy S.p.A.
Antonio Saverio Roscini: Takeda Italy S.p.A.
Gennaro Martino: Takeda Italy S.p.A.

PharmacoEconomics - Open, 2024, vol. 8, issue 5, No 6, 714 pages

Abstract: Abstract Background Today, there are many treatment options available for the management of ulcerative colitis, creating challenges in selecting the most efficacious and cost-effective treatment sequences. Treatments in the anti-tumor necrosis factor alpha (TNFα) therapeutic class, as well as vedolizumab, are widely used and endorsed as first-line options according to treatment guidelines. The aim of this study was to compare treatment sequences involving vedolizumab and the anti-TNFα treatment adalimumab in terms of cost-effectiveness in the treatment of moderately to severely active ulcerative colitis in Italy. Methods A cost-effectiveness model comparing treatment sequences within the Italian National Health Service in terms of costs and quality-adjusted life years (QALYs) with a lifetime horizon was developed. The analysis focused on the relative positioning of vedolizumab and adalimumab, leveraging the results of the landmark head-to-head VARSITY clinical trial as key inputs. The robustness of the results was investigated through a range of sensitivity and scenario analyses. Results The strategy of vedolizumab as a first-line advanced therapy followed by adalimumab was associated with higher costs and health benefits compared with first-line adalimumab followed by vedolizumab. The incremental cost-effectiveness ratio was €16,146/QALY, which was found to be robust to changes to inputs associated with areas of high uncertainty. Conclusion This economic evaluation estimated a 94% probability that vedolizumab as a first-line advanced therapy is cost-effective at a threshold of €33,004/QALY when compared with first-line adalimumab sequences. Using clinical trial evidence to inform the efficacy of second-line treatments estimated that the effectiveness of anti-TNFα treatments is not substantially reduced by vedolizumab exposure.

Date: 2024
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DOI: 10.1007/s41669-024-00497-4

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