Cost-Effectiveness of Belimumab for the Treatment of Adults With Active Lupus Nephritis in Canada
Author(s)
Justin Riemer, MBiotech1, Kelly Campbell, PhD2, Erin Arthurs, MSc1, Christopher Knight, MSc2.
1GSK, Mississauga, ON, Canada, 2RTI Health Solutions, Manchester, United Kingdom.
1GSK, Mississauga, ON, Canada, 2RTI Health Solutions, Manchester, United Kingdom.
Presentation Documents
OBJECTIVES: To evaluate the costs and health outcomes of belimumab plus standard therapy (ST) versus ST alone for the treatment of adults with active lupus nephritis (LN) in Canada from a healthcare payer perspective.
METHODS: A cohort-level Markov model was developed with health states classified by estimated glomerular filtration rate (eGFR; mL/min/1.73 m2) and dialysis/renal transplant status. Population characteristics and treatment effects were based on the BLISS-LN trial. Transition probabilities were informed by published sources. Long-term renal function was based on eGFR slope during BLISS-LN. ST comprised intravenous cyclophosphamide induction followed by azathioprine maintenance (CYC→AZA) or mycophenolate mofetil (MMF) alone. Cost (2021/2022 $CAD) and health outcomes were discounted at 1.5%. One-way sensitivity and scenario analyses were performed to evaluate robustness of results. The base-case analysis was probabilistic. Pairwise comparisons were performed for belimumab plus CYC→AZA versus CYC→AZA and belimumab plus MMF versus MMF alone.
RESULTS: Belimumab plus CYC→AZA and belimumab plus MMF were more costly and more effective than CYC→AZA and MMF alone, with mean incremental cost-utility ratios (ICURs) of $515,277 and $345,269, respectively. Patients receiving belimumab incurred lower disease management costs (versus CYC→AZA: -$57,909; versus MMF: -$84,151), mainly due to a reduction in hospitalizations and dialysis/renal transplants, and lower flare management (versus CYC→AZA: -$2,554; versus MMF: -$2,658). Overall, belimumab was associated with increased quality-adjusted life years (QALYs) (versus CYC→AZA: 0.41; versus MMF: 0.57) due to reduction in disease progression (versus CYC→AZA: +0.28; versus MMF: +0.47), reduced flares (versus CYC→AZA: +0.08; versus MMF: +0.08), and steroid sparing (versus CYC→AZA: +0.06; versus MMF: +0.02).
CONCLUSIONS: Although belimumab’s cost-effectiveness results did not align with conventional willingness-to-pay thresholds in Canada, belimumab was associated with a reduction in disease management due to slower disease progression, steroid sparing, and reduced disease flares.
FUNDING: GSK (GSK Study 218218). Editorial support (GSK-funded): Fishawack Indicia Ltd., UK, part of Avalere Health.
METHODS: A cohort-level Markov model was developed with health states classified by estimated glomerular filtration rate (eGFR; mL/min/1.73 m2) and dialysis/renal transplant status. Population characteristics and treatment effects were based on the BLISS-LN trial. Transition probabilities were informed by published sources. Long-term renal function was based on eGFR slope during BLISS-LN. ST comprised intravenous cyclophosphamide induction followed by azathioprine maintenance (CYC→AZA) or mycophenolate mofetil (MMF) alone. Cost (2021/2022 $CAD) and health outcomes were discounted at 1.5%. One-way sensitivity and scenario analyses were performed to evaluate robustness of results. The base-case analysis was probabilistic. Pairwise comparisons were performed for belimumab plus CYC→AZA versus CYC→AZA and belimumab plus MMF versus MMF alone.
RESULTS: Belimumab plus CYC→AZA and belimumab plus MMF were more costly and more effective than CYC→AZA and MMF alone, with mean incremental cost-utility ratios (ICURs) of $515,277 and $345,269, respectively. Patients receiving belimumab incurred lower disease management costs (versus CYC→AZA: -$57,909; versus MMF: -$84,151), mainly due to a reduction in hospitalizations and dialysis/renal transplants, and lower flare management (versus CYC→AZA: -$2,554; versus MMF: -$2,658). Overall, belimumab was associated with increased quality-adjusted life years (QALYs) (versus CYC→AZA: 0.41; versus MMF: 0.57) due to reduction in disease progression (versus CYC→AZA: +0.28; versus MMF: +0.47), reduced flares (versus CYC→AZA: +0.08; versus MMF: +0.08), and steroid sparing (versus CYC→AZA: +0.06; versus MMF: +0.02).
CONCLUSIONS: Although belimumab’s cost-effectiveness results did not align with conventional willingness-to-pay thresholds in Canada, belimumab was associated with a reduction in disease management due to slower disease progression, steroid sparing, and reduced disease flares.
FUNDING: GSK (GSK Study 218218). Editorial support (GSK-funded): Fishawack Indicia Ltd., UK, part of Avalere Health.
Conference/Value in Health Info
2025-05, ISPOR 2025, Montréal, Quebec, CA
Value in Health, Volume 28, Issue S1
Code
P38
Topic
Economic Evaluation
Disease
SDC: Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain), STA: Biologics & Biosimilars