Cost-utility analysis of infliximab and adalimumab for refractory ulcerative colitis

Abstract

ObjectiveTo evaluate cost-utility of infliximab and adalimumab for the treatment of moderate-to-severe ulcerative colitis (UC) refractory to conventional therapies in Canada.MethodsA Markov model was constructed to evaluate incremental cost-utility ratios (ICUR) of 5 mg/kg and 10 mg/kg infliximab and adalimumab therapies compared to 'usual care' in treating a hypothetical cohort of patients (aged 40 years and weighing 80 kg) over a five-year time horizon from the perspective of a publicly-funded health care system. Clinical parameters were derived from the Active Ulcerative Colitis Trials 1 and 2. Costs were obtained through provincial drug benefit plans. ICUR was the main outcome measure and both deterministic and probabilistic sensitivity analyses were conducted.ResultsCompared to the strategy A ('usual care') in the base case analysis, the ICURs were CA$358,088/QALY for the strategy B ('5 mg/kg infliximab + adalimumab') and CA$575,540/QALY for the strategy C ('5 mg/kg and 10 mg/kg infliximab + adalimumab'). The results were sensitive to: the remission rates maintained in responders to 'usual care' and to 5 mg/kg infliximab, the rate of remission induced by adalimumab in non-responders to 5 mg/kg infliximab, early surgery rate, and utility values. When the willingness to pay (WTP) was less than CA$150,000/QALY, the probability of 'usual care' being the optimal strategy was 1.0. The probability of strategy B being optimal was 0.5 when the WTP approximated CA$400,000/QALY.ConclusionsThe ICURs of anti-TNF-α drugs were not satisfactory in treating patients with moderate-to-severe refractory UC. Future research could be aimed at the long-term clinical benefits of these drugs, especially adalimumab for patients intolerant or unresponsive to infliximab treatment.

Infliximab, adalimumab and golimumab for treating moderately to severely active ulcerative colitis after the failure of conventional therapy (including a review of TA140 and TA262): clinical effectiveness systematic review and economic model

“…PSA was also conducted with decision uncertainty represented using cost-effectiveness acceptability curves (CEACs). Table 38 presents the headline cost-effectiveness results reported by Xie et al 84 The model analysis suggests that the strategy B is expected to produce more health gain than strategies A and C. Strategy C is dominated by strategy B. The incremental cost-effectiveness of strategy B versus usual care was estimated to be approximately CA$358,823 per QALY gained.…”

“…Overall, the analysis reported by Xie et al 84 appears to adequately address the decision problem using a generally appropriate model. However, the analysis is limited by the use of a short time horizon, the absence of surgery as a comparator and questionable assumptions regarding the health gains associated with achieving response without remission.…”

“…[82][83][84] Cost-effectiveness evaluation of golimumab (with Patient Access Scheme), infliximab and adalimumab relative to colectomy for moderate to severe ulcerative colitis in the UK (MSD submissions 64,66 ) and Adalimumab, golimumab and infliximab, for the treatment of ulcerative colitis (subacute) -AbbVie submission 62 present critical reviews of the individual manufacturers' submissions from AbbVie and MSD, respectively.…”

“…All health utilities were drawn from a previous economic modelling study reported by Arseneau et al 110 The method of utility elicitation within this study appears to be TTO. 84 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.…”

“…Xie et al 84 Xie et al 84 report a cost-effectiveness analysis comparing IFX plus ADA versus usual care in patients with moderate to severe refractory UC in Canada. Patients were assumed to be 40 years of age with a mean body weight of 80 kg.…”