COST-EFFECTIVENESS ANALYSES OF ANTIFIBROTICS FOR THE TREATMENT OF IDIOPATHIC PULMONARY FIBROSIS: A LITERATURE REVIEW
Author(s)
Hadrien DUPOMMIER-ROUILLARD, MSc1, Paul Casabianca, MSc, PharmD2, Sebastien Branchoux, MSc, PhD2.
1Master 2 Market Access and Health Economic Evaluation, Gif-sur-Yvette, France, 2HEOR, Bristol Myers Squibb France, Rueil-Malmaison, France.
1Master 2 Market Access and Health Economic Evaluation, Gif-sur-Yvette, France, 2HEOR, Bristol Myers Squibb France, Rueil-Malmaison, France.
OBJECTIVES: Idiopathic pulmonary fibrosis (IPF) is a rare, fatal interstitial lung disease. Nintedanib and pirfenidone are the only approved antifibrotics, although new therapies are expected in Europe soon. This study aimed to summarize their cost-effectiveness analyses (CEAs) in IPF, by comparing structural choices and base-case results.
METHODS: MEDLINE and Embase were searched from inception to 31 May 2026 to identify CEAs of nintedanib and/or pirfenidone in IPF reporting incremental cost-effectiveness or cost-utility ratios (ICERs or ICURs). Reports published in English or French were eligible, while analyses including non-exclusively IPF populations were excluded. Study selection followed the PRISMA 2020 framework. Data on model structures, perspectives, costs, and ICERs/ICURs were extracted and synthesized narratively. This extraction was restricted to nintedanib, pirfenidone, and best supportive care/placebo arms.
RESULTS: Sixteen studies (20 reports, including 12 posters) were included. Markov models predominated, with two main structures: a 17-state forced vital capacity (FVC)-based model (n = 7) and a 4-state progression-based model (n = 5). All nintedanib-manufacturer-funded studies used the 17-state structure, and all pirfenidone-manufacturer-funded studies used the 4-state structure. Network meta-analysis was the most common method for treatment comparison (n = 13). Settings spanned 10 countries (most frequently the United States, n = 3). Perspectives varied; compulsory health insurance (n = 8) and healthcare system (n = 3) were most commonly adopted. Cost components were homogeneous across studies; no study included indirect costs. Fifteen studies compared both nintedanib and pirfenidone. Nintedanib dominated pirfenidone in 8/14 QALY-based and 4/10 LYG-based analyses; pirfenidone dominated nintedanib in 2/14 and 3/10, respectively. In the remaining studies, ICERs varied widely (€8,199 to $896,494/QALY).
CONCLUSIONS: In most included studies, one antifibrotic dominated the other. In sponsored studies, the funding manufacturer’s drug was consistently found dominant, using its typical model structure. Overall, these CEAs provide a methodological reference for the upcoming evaluations of emerging IPF therapies.
METHODS: MEDLINE and Embase were searched from inception to 31 May 2026 to identify CEAs of nintedanib and/or pirfenidone in IPF reporting incremental cost-effectiveness or cost-utility ratios (ICERs or ICURs). Reports published in English or French were eligible, while analyses including non-exclusively IPF populations were excluded. Study selection followed the PRISMA 2020 framework. Data on model structures, perspectives, costs, and ICERs/ICURs were extracted and synthesized narratively. This extraction was restricted to nintedanib, pirfenidone, and best supportive care/placebo arms.
RESULTS: Sixteen studies (20 reports, including 12 posters) were included. Markov models predominated, with two main structures: a 17-state forced vital capacity (FVC)-based model (n = 7) and a 4-state progression-based model (n = 5). All nintedanib-manufacturer-funded studies used the 17-state structure, and all pirfenidone-manufacturer-funded studies used the 4-state structure. Network meta-analysis was the most common method for treatment comparison (n = 13). Settings spanned 10 countries (most frequently the United States, n = 3). Perspectives varied; compulsory health insurance (n = 8) and healthcare system (n = 3) were most commonly adopted. Cost components were homogeneous across studies; no study included indirect costs. Fifteen studies compared both nintedanib and pirfenidone. Nintedanib dominated pirfenidone in 8/14 QALY-based and 4/10 LYG-based analyses; pirfenidone dominated nintedanib in 2/14 and 3/10, respectively. In the remaining studies, ICERs varied widely (€8,199 to $896,494/QALY).
CONCLUSIONS: In most included studies, one antifibrotic dominated the other. In sponsored studies, the funding manufacturer’s drug was consistently found dominant, using its typical model structure. Overall, these CEAs provide a methodological reference for the upcoming evaluations of emerging IPF therapies.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE421
Topic
Economic Evaluation
Topic Subcategory
Trial-Based Economic Evaluation
Disease
Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory)