A Cost-Effectiveness Analysis of Ustekinumab Against Vedolizumab Among Inflammatory Bowel Disease Patients With Extra-intestinal Manifestations in Egypt
Author(s)
Mariam M. Elattar, MBA1, Nageh Louis, MSc, PhD2, Ezzat Ali, MSc, PhD3, Ahmed Mohammed Seyam, MSc4, Rania Abdelaziz, MD4, Gihan Hamdy Elsisi, Sr., BSc, MSc, PhD5.
1HEOR, HTA Office, Middle East and North Africa, Cairo, Egypt, 2Universal Health Insurance Authority, Ismailia, Egypt, 3Faculty of Medicine, Alexandria University, Alexandria, Egypt, 4Universal Health Insurance Authority, Cairo, Egypt, 5The American University in Cairo, cairo, Egypt.
1HEOR, HTA Office, Middle East and North Africa, Cairo, Egypt, 2Universal Health Insurance Authority, Ismailia, Egypt, 3Faculty of Medicine, Alexandria University, Alexandria, Egypt, 4Universal Health Insurance Authority, Cairo, Egypt, 5The American University in Cairo, cairo, Egypt.
OBJECTIVES: Inflammatory bowel disease (IBD) represents a substantial clinical burden, characterized by chronic gastrointestinal symptoms and severe complications. A significant proportion of IBD patients develop extra-intestinal manifestations (EIMs), which lead to high management costs and quality of life (QoL) impairment. This cost-effectiveness analysis, conducted from the perspective of the national payer in Egypt, aimed to compare the effectiveness of ustekinumab against vedolizumab in managing EIMs among IBD patients.
METHODS: This cost-utility analysis was conducted using a decision tree model over a one-year time horizon. The model captured clinical outcomes of biologic-experienced IBD patients with pre-existing EIMs across mutually exclusive health states, including joint, skin, ocular, hepatic and oral manifestations. Treatment patterns and local clinical practice inputs were informed by gastroenterologists practicing in Egypt. Clinical parameters, encompassing EIMs outcomes (improvement, stable, worsening) observed with each treatment arm, were primarily sourced from a published systematic review and meta-analysis, with unit costs sourced from local Egyptian authorities (UPA, UHIA). The model encompassed direct medical costs as drug acquisition, follow-up costs, and additional resources required to manage worsened EIMs. Health outcomes were expressed as quality-adjusted life-years (QALYs), including disease-specific utilities and EIMs-related utility decrements from published literature. One-way sensitivity analysis assessed the model robustness.
RESULTS: Over a one-year time horizon, ustekinumab generated 0.79 QALYs at a total cost of EGP 188,584, compared to 0.64 QALYs and EGP 163,907 for vedolizumab. This yielded a QALY gain of 0.15 at an additional cost of EGP 24,677. When comparing ustekinumab to vedolizumab, the incremental cost-effectiveness ratio (ICER) of EGP 167,927 per QALY was below the cost-effectiveness threshold of EGP 177,366 (equivalent to 2× Egypt’s GDP per capita).
CONCLUSIONS: The analysis demonstrated that ustekinumab offers superior clinical outcomes and QoL improvement compared to vedolizumab for IBD patients with pre-existing EIMs, while being a cost-effective option within the Egyptian healthcare system.
METHODS: This cost-utility analysis was conducted using a decision tree model over a one-year time horizon. The model captured clinical outcomes of biologic-experienced IBD patients with pre-existing EIMs across mutually exclusive health states, including joint, skin, ocular, hepatic and oral manifestations. Treatment patterns and local clinical practice inputs were informed by gastroenterologists practicing in Egypt. Clinical parameters, encompassing EIMs outcomes (improvement, stable, worsening) observed with each treatment arm, were primarily sourced from a published systematic review and meta-analysis, with unit costs sourced from local Egyptian authorities (UPA, UHIA). The model encompassed direct medical costs as drug acquisition, follow-up costs, and additional resources required to manage worsened EIMs. Health outcomes were expressed as quality-adjusted life-years (QALYs), including disease-specific utilities and EIMs-related utility decrements from published literature. One-way sensitivity analysis assessed the model robustness.
RESULTS: Over a one-year time horizon, ustekinumab generated 0.79 QALYs at a total cost of EGP 188,584, compared to 0.64 QALYs and EGP 163,907 for vedolizumab. This yielded a QALY gain of 0.15 at an additional cost of EGP 24,677. When comparing ustekinumab to vedolizumab, the incremental cost-effectiveness ratio (ICER) of EGP 167,927 per QALY was below the cost-effectiveness threshold of EGP 177,366 (equivalent to 2× Egypt’s GDP per capita).
CONCLUSIONS: The analysis demonstrated that ustekinumab offers superior clinical outcomes and QoL improvement compared to vedolizumab for IBD patients with pre-existing EIMs, while being a cost-effective option within the Egyptian healthcare system.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE11
Topic
Economic Evaluation, Health Technology Assessment, Medical Technologies
Disease
Gastrointestinal Disorders, No Additional Disease & Conditions/Specialized Treatment Areas