Avacopan in the Treatment of ANCA-Associated Vasculitis: A Cost-Utility Analysis in Portugal
Author(s)
Diogo Mendes, PhD1, Carlos Alves, PhD2, Daniel Figueiredo, PhD3, Beatriz Costa, MSc1, Ana Penedones, PhD1, Antonio Ramirez de Arellano Serna, MSc, DPhil4, Francisco Batel Marques, PhD5.
1Clevidence, Oeiras, Portugal, 2Assistant Professor, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal, 3Center for Research and Development in Mathematics and Applications, University of Aveiro, Aveiro, Portugal, 4HEOR, CSL Vifor, Zurich, Switzerland, 5Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
1Clevidence, Oeiras, Portugal, 2Assistant Professor, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal, 3Center for Research and Development in Mathematics and Applications, University of Aveiro, Aveiro, Portugal, 4HEOR, CSL Vifor, Zurich, Switzerland, 5Laboratory of Social Pharmacy and Public Health, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
OBJECTIVES: Granulomatosis with polyangiitis (GPA) and microscopic polyangiitis (MPA) are two forms of anti-neutrophil cytoplasmic autoantibody associated vasculitis (AAV), impacting patient morbidity, mortality, and quality of life. Current standard of care is associated to high rate of relapse, glucocorticoids (GCs) related infections and complications and rapid disease progression. This study is a cost- utility analysis of using avacopan (rather than high-dose glucocorticoids) in combination with rituximab (RTX) or cyclophosphamide (CYC) regimen in the treatment of adults with severe, active GPA or MPA from the perspective of the Portuguese NHS.
METHODS: A Markov model contemplating 9 health states (HS) (active disease, remission (n=3), relapse (n=3), end-stage renal disease [ESRD], death) simulated the AAV course, namely induction and maintenance phases to induce remission and prevent relapses, respectively. Transition probabilities between HS were calculated using data from the ADVOCATE trial (‘active disease’, ‘remission’ and ‘relapse’) and other real-world evidence sources (‘ESRD’ and ‘death’). Utilities from ADVOCATE were used to estimate quality-adjusted life years (QALYs). Use of resources was elicited by an expert panel. Costs (e.g., drugs, disease monitoring, adverse events) were collected from Portuguese official sources and literature. Costs and benefits were discounted at a 4% annual rate over a lifetime horizon. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were performed.
RESULTS: The use of avacopan generated +0.273 life-years (LYs) and +0.337 QALYs at an additional cost of €34,416 compared to glucocorticoids (both in combination with an RTX or CYC regimen). The ICER for that comparison was estimated at €102,036 per QALY gained. The model results were robust according to DSA/PSA.
CONCLUSIONS: Avacopan + RTX/CYC higher drug costs are substantially offset by the reduction of relapses, GCs-related infections and complications along with the slowing down of progression to ESRD, resulting in higher LYs, QALYs and in a cost-effective treatment for Portuguese healthcare system.
METHODS: A Markov model contemplating 9 health states (HS) (active disease, remission (n=3), relapse (n=3), end-stage renal disease [ESRD], death) simulated the AAV course, namely induction and maintenance phases to induce remission and prevent relapses, respectively. Transition probabilities between HS were calculated using data from the ADVOCATE trial (‘active disease’, ‘remission’ and ‘relapse’) and other real-world evidence sources (‘ESRD’ and ‘death’). Utilities from ADVOCATE were used to estimate quality-adjusted life years (QALYs). Use of resources was elicited by an expert panel. Costs (e.g., drugs, disease monitoring, adverse events) were collected from Portuguese official sources and literature. Costs and benefits were discounted at a 4% annual rate over a lifetime horizon. Deterministic (DSA) and probabilistic sensitivity analyses (PSA) were performed.
RESULTS: The use of avacopan generated +0.273 life-years (LYs) and +0.337 QALYs at an additional cost of €34,416 compared to glucocorticoids (both in combination with an RTX or CYC regimen). The ICER for that comparison was estimated at €102,036 per QALY gained. The model results were robust according to DSA/PSA.
CONCLUSIONS: Avacopan + RTX/CYC higher drug costs are substantially offset by the reduction of relapses, GCs-related infections and complications along with the slowing down of progression to ESRD, resulting in higher LYs, QALYs and in a cost-effective treatment for Portuguese healthcare system.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE70
Topic
Economic Evaluation, Health Technology Assessment, Methodological & Statistical Research
Disease
Cardiovascular Disorders (including MI, Stroke, Circulatory), Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)