Cost-Effectiveness of Different Strategies for the Treatment of Moderate-to-Severe Ulcerative Colitis

Cost-Effectiveness Analysis of Vedolizumab Compared with Other Biologics in Anti-TNF-Naïve Patients with Moderate-to-Severe Ulcerative Colitis in Japan

“…In the study by Wilson et al (2018) for the UK, the time horizon of analysis was lifetime and the QALYs for the biologics ranged between 13.79 and 14.08; in this study by Wilson et al, the health states were not based on response and remission, but on disease severity (moderate-severe, mild, and remission) [18]. The utility value used for patients in remission was 0.87, in line with our analysis and the other studies for the UK, Spain and China [19,46,47]; however, the utility values used by Wilson et al, for the mild and moderate-severe UC health states were 0.80 and 0.68, respectively, which are higher than those for the response-only (0.76) and active UC (0.41 or 0.42) health states used in our analysis and the other studies [19,46,47]. Although Wilson et al used lower utility values compared to our analysis for the surgery, post-surgery remission, and post-surgery complications health states (0.42 vs. 0.66, 0.60 vs. 0.71, and 0.42 vs. 0.66, respectively) [18], the low number of surgeries and complications does not offset the additional QALYs accrued with a higher utility value for the mild and moderate-severe UC health states in the study by Wilson et al versus those used in our analysis for the response-only and active UC health states.…”

“…ADA adalimumab, GOL golimumab, IFX infliximab, QALY quality-adjusted life-year, VDZ vedolizumab; WTP willingness-to-pay compared with ADA and IFX, with ICERs lower than with a lifetime horizon in the base case (¥4,089,246 and ¥3,577,489, respectively). A third study assessed the costeffectiveness of treatment strategies/sequences of treatments for the treatment of moderate-to-severe UC patients who were anti-TNF-naïve in the UK and China [47]. Consistent with our study and the previous studies in the UK and Spain, long-term treatment with VDZ was associated with greater QALYs compared with ADA, GOL, and IFX when all biologics were followed by CT after biologic discontinuation.…”

“…Although Wilson et al used lower utility values compared to our analysis for the surgery, post-surgery remission, and post-surgery complications health states (0.42 vs. 0.66, 0.60 vs. 0.71, and 0.42 vs. 0.66, respectively) [18], the low number of surgeries and complications does not offset the additional QALYs accrued with a higher utility value for the mild and moderate-severe UC health states in the study by Wilson et al versus those used in our analysis for the response-only and active UC health states. In the study by Wu et al (2018), the time horizon of analysis was lifetime and the QALYs for biologics (ADA, GOL, IFX, and VDZ) followed by CT after discontinuation ranged between 10.71 and 11.48 in the analysis for the UK, and between 8.16 and 8.92 in the analysis for China [47]. All the efficacy and utility parameters used in the analyses by Wu et al were the same for the UK and China, except for the life expectancy tables, which were country specific; the difference in the life expectancy seems to be the only explanation for having different QALYs between the analyses for the UK and China, although life-years are not reported in the study to confirm this.…”

“…In our study, we used Japanese life tables published by the MHLW to model mortality, which could explain the higher QALYs for biologics reported in our study as the life expectancy in Japan (84 years) is higher than that in the UK (81 years) and China (76 years) [57]. The utility values used in our analysis were almost the same as those used by Wu et al [47], except for the surgery health states remission (0.88 in the study by Wu et al vs. 0.87 in our analysis), response-only (0.76 in both analyses), active UC (0.42 vs. 0.41), post-surgery remission (0.60 vs. 0.71), and post-surgery complications (0.42 vs. 0.66). We ran a scenario in our model using the utility values used by Wu et al, and VDZ remained dominant compared with GOL and cost-effective compared with ADA and IFX, with ICERs lower than in the base case (¥4,358,589 and ¥4,065,464, respectively).…”

“…We decided to make this assumption and excluded subsequent lines of biologic treatment as including this feature could mask the true value of a specific first-line biologic, as benefits could result from other subsequent treatments. However, future analyses should examine the cost-effectiveness of different treatment sequences, to obtain information regarding the cost-effectiveness of specific sequences of biologics, and of individual biologics as part of a sequence of treatments and where they should be placed to maximize health economic value; the study by Wu et al, can provide a starting point for the future analyses [47]. Fifth, in this analysis we focused on comparing VDZ with other biologics in anti-TNF-naïve patients with moderate-to-severe UC.…”