Adalimumab for non-infectious uveitis: is it cost-effective?

Abstract

Background/AimsUveitis is inflammation inside the eye. Our objective was to assess the cost-effectiveness of adalimumab compared with current practice (immunosuppressants and systemic corticosteroids) in patients with non-infectious intermediate, posterior or panuveitis and to identify areas for future research.MethodsA Markov model was built to estimate costs and benefits of the interventions. Systematic reviews were performed to identify the available relevant clinical and cost-effectiveness evidence. Data collected in two key randomised controlled trials (VISUAL I and VISUAL II) were used to estimate the interventions’ effectiveness compared with the trials’ comparator arms (placebo plus limited current practice (LCP)). The analysis was performed from the National Health Service and Personal Social Services perspective. Costs were calculated based on standard UK sources.ResultsThe estimated incremental cost-effectiveness ratios (ICERs) of adalimumab versus LCP for the base case are £92 600 and £318 075 per quality-adjusted life year (QALY) gained for active and inactive uveitis, respectively. In sensitivity analyses, the ICER varied from £15 579 to £120 653 and £35 642 to £800 775 per QALY for active and inactive uveitis.ConclusionThe estimated ICERs of adalimumab versus LCP are above generally accepted thresholds for cost-effectiveness in the UK. Adalimumab may be more cost-effective in patients with active uveitis at greater risk of blindness. However, there is an unmet need for additional primary data to provide more reliable estimates in several important areas, including effectiveness of adalimumab versus current practice (instead of LCP), incidence of long-term blindness, adalimumab effectiveness in avoiding blindness, and rates and time to remission while on adalimumab.

Use of biologics in non‐infectious uveitis: the situation in northern England

“…It has been previously highlighted elsewhere, 5 and this is certainly going to remain an important topic for countries such as the UK where costs of drug therapies are scrutinised by the National Institute for Health and Care Excellence. 6 In the UK adalimumab is therefore now used when the uveitis is inadequately responsive to steroids or other immunosuppressants.…”

Adalimumab for the Treatment of Adults With Non-Infectious Uveitis

“…3 Non-infectious uveitis may be idiopathic, caused by a reaction to a medication (but this is rare), or immune-mediated; therefore, it presents among many systemic autoimmune diseases such as juvenile idiopathic arthritis, Behçet's disease, or ankylosing spondylitis. 1,3,4 Of note, this report focuses on adults with non-infectious uveitis. As juvenile idiopathic arthritis predominantly affects pediatric patients much of the included evidence will not focus on this patient population.…”

“…5 If left untreated, uveitis may lead to vision loss, early complications such as cystoid macular edema and vitreous haze, and late complications such as cataracts, glaucoma, and irreversible retinal damage. 4 Treatment for non-infectious uveitis depends on whether it presents alongside a systemic disease (and if the disease is controlled), if the inflammation affects 1 (unilateral) or both (bilateral) eyes, and if there is anatomic localization of the uveitis. 4,6 Initially, it is usually treated with corticosteroids with topical (e.g., prednisolone acetate drops) or local (e.g., intravitreal implants or injections or periocular injections) administration.…”

“…4 Treatment for non-infectious uveitis depends on whether it presents alongside a systemic disease (and if the disease is controlled), if the inflammation affects 1 (unilateral) or both (bilateral) eyes, and if there is anatomic localization of the uveitis. 4,6 Initially, it is usually treated with corticosteroids with topical (e.g., prednisolone acetate drops) or local (e.g., intravitreal implants or injections or periocular injections) administration. For instance, posterior-, intermediate-, or panuveitis is initially treated with triamcinolone (glucocorticoid); of note, posterior non-infectious uveitis is typically not responsive to topical medication.…”

A Review of the Various Roles and Participation Levels of B-Cells in Non-Infectious Uveitis

“…It is classified into either infectious or non-infectious uveitis. Non-infectious uveitis is believed to be autoimmune or immune-mediated (4) and is the more prevalent subtype in developed countries (5). Corticosteroids have always been the cornerstone of non-infectious uveitis treatment, albeit with serious side effects due to long-term and high-dose use (6).…”