MECHANISM-OF-ACTION-BASED COST-EFFECTIVENESS ANALYSIS OF INNOVATIVE DRUGS FOR MODERATE-TO-SEVERE ULCERATIVE COLITIS IN HONG KONG - A MARKOV MODEL WITH NETWORK META-ANALYSIS INPUTS
Author(s)
Qiwen Fang, MPH1, Yin ZHANG, MPH2, Zonglin Dai, PhD2, Xue Li, PhD2.
1Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong, 2Department of Medicine and CSMPR, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong.
1Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong, 2Department of Medicine and CSMPR, Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong, Hong Kong.
OBJECTIVES: In Hong Kong, several novel therapies for moderate-to-severe ulcerative colitis (UC) remained unavailable by the end of 2024 despite overseas regulatory approval or supportive phase 3 evidence, limiting local evidence for treatment and reimbursement decisions. This study evaluated the cost-effectiveness of first-line novel treatments from the Hong Kong healthcare provider's perspective.
METHODS: A lifetime Markov model was developed to simulate the clinical pathway of moderate-to-severe UC, including active disease, clinical response, colectomy, post-surgery remission or complications, and death, with treatment-specific transition probabilities informed by network meta-analysis. Mechanism-of-action-based novel strategies - Janus kinase (JAK) inhibitors, sphingosine-1-phosphate (S1P) receptor modulators, anti-tumour necrosis factor-alpha agents (anti-TNF), and interleukin-23 (IL-23) inhibitors - plus conventional therapy were compared with conventional therapy alone. Primary outcomes were quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs), assessed against one- and three-times Hong Kong GDP per capita thresholds in 2024. Deterministic and probabilistic sensitivity analyses were conducted.
RESULTS: Compared with conventional therapy, incremental QALYs were 0.11 for JAK inhibitors, 0.05 for S1P receptor modulators, 0.04 for anti-TNF agents, and 0.09 for IL-23 inhibitors. Expected surgery-free clinical response duration increased from 22.1 years with conventional therapy alone to 22.9, 22.5, 22.4, and 22.7 years, respectively. Corresponding ICERs were HK$1,496,816, HK$2,812,496, HK$3,742,912, and HK$3,307,232 per QALY. Novel strategies increased drug acquisition costs but reduced disease management, surgery-related costs, and adverse event costs. At the three-times GDP per capita threshold, the probability of cost-effectiveness was 73.9% for conventional therapy, 26.0% for novel JAK inhibitors, and <0.1% for other novel strategies.
CONCLUSIONS: Among the novel strategies assessed, JAK inhibitors showed the most favorable cost-effectiveness profile. Although the base-case ICERs exceeded the three-times GDP per capita threshold, sensitivity analyses indicated that cost-effectiveness was influenced by key clinical and cost parameters. Drug price optimization may further improve the value of novel therapies for moderate-to-severe UC.
METHODS: A lifetime Markov model was developed to simulate the clinical pathway of moderate-to-severe UC, including active disease, clinical response, colectomy, post-surgery remission or complications, and death, with treatment-specific transition probabilities informed by network meta-analysis. Mechanism-of-action-based novel strategies - Janus kinase (JAK) inhibitors, sphingosine-1-phosphate (S1P) receptor modulators, anti-tumour necrosis factor-alpha agents (anti-TNF), and interleukin-23 (IL-23) inhibitors - plus conventional therapy were compared with conventional therapy alone. Primary outcomes were quality-adjusted life-years (QALYs) and incremental cost-effectiveness ratios (ICERs), assessed against one- and three-times Hong Kong GDP per capita thresholds in 2024. Deterministic and probabilistic sensitivity analyses were conducted.
RESULTS: Compared with conventional therapy, incremental QALYs were 0.11 for JAK inhibitors, 0.05 for S1P receptor modulators, 0.04 for anti-TNF agents, and 0.09 for IL-23 inhibitors. Expected surgery-free clinical response duration increased from 22.1 years with conventional therapy alone to 22.9, 22.5, 22.4, and 22.7 years, respectively. Corresponding ICERs were HK$1,496,816, HK$2,812,496, HK$3,742,912, and HK$3,307,232 per QALY. Novel strategies increased drug acquisition costs but reduced disease management, surgery-related costs, and adverse event costs. At the three-times GDP per capita threshold, the probability of cost-effectiveness was 73.9% for conventional therapy, 26.0% for novel JAK inhibitors, and <0.1% for other novel strategies.
CONCLUSIONS: Among the novel strategies assessed, JAK inhibitors showed the most favorable cost-effectiveness profile. Although the base-case ICERs exceeded the three-times GDP per capita threshold, sensitivity analyses indicated that cost-effectiveness was influenced by key clinical and cost parameters. Drug price optimization may further improve the value of novel therapies for moderate-to-severe UC.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE488
Topic
Economic Evaluation, Study Approaches
Disease
Biologics & Biosimilars, Gastrointestinal Disorders