Cost-Effectiveness of Etrasimod, Ozanimod, and Adalimumab Compared to Infliximab in Treatment-Naive Patients With Moderate to Severe Ulcerative Colitis
Author(s)
Atreya Ghosh, BSPS, Thuy Pham, BSPS, Kangho Suh, PharmD, PhD.
Department of Pharmacy & Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.
Department of Pharmacy & Therapeutics, University of Pittsburgh School of Pharmacy, Pittsburgh, PA, USA.
OBJECTIVES: Ulcerative Colitis (UC) is an autoimmune disease characterized by chronic mucosal inflammation in the rectum and large intestine. Infliximab and adalimumab are established biologic therapies, while ozanimod and etrasimod are newer oral S1P receptor modulators; all are considered first-line options for moderate-to-severe UC. The objective of this study was to assess the cost effectiveness of etrasimod, ozanimod, and adalimumab compared to infliximab in this patient population.
METHODS: We developed a lifetime Markov model from the US health care sector perspective with health states for active UC, response, remission, complications after surgery, remission after surgery, and death. Patients could transition through first line therapy with etrasimod, ozanimod, adalimumab, or infliximab, followed by second-line upadactinib, and third-line tofactinib before surgery was modeled. Clinical transition probabilities were derived from published clinical trials and a network meta-analysis, while cost inputs were sourced from the literature and the Federal Supply Schedule. All costs and outcomes were discounted at 3% annually. We conducted one-way sensitivity analyses to identify influential parameters and probabilistic sensitivity analyses to evaluate overall model robustness.
RESULTS: Over the patient’s lifetime, first-line use of etrasimod, ozanimod, and adalimumab resulted in comparable quality-adjusted life-years to infliximab (range: 13.31-13.36). This reflects the assumption that none of the treatments impact mortality, resulting in similar life-years across arms and consequently similar QALYs. Ozanimod generated a small QALY gain relative to infliximab but had an incremental cost-effectiveness ratio exceeding $5 million per QALY gained. Both etrasimod and adalimumab were dominated by infliximab.
CONCLUSIONS: These results suggest that, given similar life-years and QALYs across treatments, cost differences are the primary driver. In this analysis, infliximab emerged as the preferred first-line option due to its lower costs without compromising health outcomes.
METHODS: We developed a lifetime Markov model from the US health care sector perspective with health states for active UC, response, remission, complications after surgery, remission after surgery, and death. Patients could transition through first line therapy with etrasimod, ozanimod, adalimumab, or infliximab, followed by second-line upadactinib, and third-line tofactinib before surgery was modeled. Clinical transition probabilities were derived from published clinical trials and a network meta-analysis, while cost inputs were sourced from the literature and the Federal Supply Schedule. All costs and outcomes were discounted at 3% annually. We conducted one-way sensitivity analyses to identify influential parameters and probabilistic sensitivity analyses to evaluate overall model robustness.
RESULTS: Over the patient’s lifetime, first-line use of etrasimod, ozanimod, and adalimumab resulted in comparable quality-adjusted life-years to infliximab (range: 13.31-13.36). This reflects the assumption that none of the treatments impact mortality, resulting in similar life-years across arms and consequently similar QALYs. Ozanimod generated a small QALY gain relative to infliximab but had an incremental cost-effectiveness ratio exceeding $5 million per QALY gained. Both etrasimod and adalimumab were dominated by infliximab.
CONCLUSIONS: These results suggest that, given similar life-years and QALYs across treatments, cost differences are the primary driver. In this analysis, infliximab emerged as the preferred first-line option due to its lower costs without compromising health outcomes.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE249
Topic
Economic Evaluation
Disease
Gastrointestinal Disorders, No Additional Disease & Conditions/Specialized Treatment Areas