OBJECTIVES : The INBUILD trial showed that nintedanib slows the rate of progression in patients with progressive fibrosing interstitial lung diseases (PF-ILD), yet its cost-effectiveness is unknown. We aimed to assess the cost-effectiveness of nintedanib versus usual care (UC) in patients with PF-ILD in the Netherlands.

METHODS

A cost-effectiveness analysis was performed for patients with PF-ILD receiving nintedanib versus UC, populated by the nintedanib- and placebo arm from the INBUILD trial, respectively. Cost-effectiveness was analysed using a Microsoft Excel based, individual patient simulation model with a 20-year time horizon. A Dutch societal perspective with 4.0% discounting for costs and 1.5% for effects was applied. Disease progression was driven by lung function decline with Forced Vital Capacity (FVC) health states ranging from <40 to ≥110 FVC%pred, using increments of 10% points. Transition probabilities were based on survival data from clinical trials and regression analyses. Direct and societal costs and disease related healthcare costs were included (cost-year 2019). Univariate and probabilistic sensitivity analyses, and scenario analyses were performed to assess the impact of parameter assumptions on the cost-effectiveness and to test model robustness.

RESULTS

Nintedanib treatment resulted in 0.97 incremental quality adjusted life years (QALYs) gained at an expense of €57,198 in comparison with UC, leading to an ICER of €59,002 per QALY. At a disease dependent willingness-to-pay (WTP) threshold of €80,000 per QALY, the probability that treatment with nintedanib is cost-effective compared with UC was 100% for the Netherlands. Results were mainly driven by disease related utilities, mortality- and FVC%pred progression probabilities. Scenario analyses indicated that the model was most sensitive to the time horizon and in- and exclusion of lung transplantation.

CONCLUSIONS : In the Netherlands, treating PF-ILD patients with nintedanib versus UC can be considered cost-effective at the established WTP-threshold for high burden diseases of €80,000 per QALY.