OBJECTIVES: Tofacitinib is an oral, small molecule JAK inhibitor for the treatment of ulcerative colitis (UC). This study assessed the cost-effectiveness of tofacitinib versus available treatments for patients with moderate-to-severe UC following an inadequate response to conventional treatment who are either naïve to or have failed previous biologics in Germany.

METHODS: A Markov cohort model was developed to evaluate differences in long-term costs and outcomes between tofacitinib and its comparators from the perspective of German statutory health insurance (SHI). The model population comprised of patients either naïve to or exposed to biologics. Tofacitinib was compared to infliximab, adalimumab, golimumab, vedolizumab, and conventional therapy. Health states modeled were remission, treatment response, active UC, and post-colectomy. Patients not responding to treatment could switch to a different treatment. Treatment efficacy for induction and maintenance phases were assessed by a systematic literature review and a network meta-analysis (NMA). The model included costs associated with drug administration, adverse events, and medical resource use. Dose escalation of biologics was informed by a recent retrospective analysis of German claims data. Extensive deterministic and probabilistic sensitivity analyses (DSA and PSA) were conducted.

RESULTS: Over a life-time horizon, patients treated with tofacitinib gained 0.014 to 0.071 quality-adjusted life-years (QALYs) and had direct cost savings to the SHI of €14,996 to €64,474 compared to other biologic treatments. DSA showed model results were most influenced by differences in treatment efficacy from the NMA, which showed a higher probability of tofacitinib having similar or better efficacy than other agents. Compared with conventional therapy, tofacitinib resulted in a lower incremental cost-effectiveness ratio than all other biologics. The PSA suggested confidence in the base-case results considering uncertainty around parameters.

CONCLUSIONS: The results of this economic model suggest tofacitinib is a cost-effective treatment option for patients with moderate-to-severe UC in Germany.