OBJECTIVES: As the therapeutic armamentarium for moderately-to-severely active ulcerative colitis (UC) continues to expand, this analysis assessed the cost per event (CPE) of advanced therapies for induction and maintenance in bio-exposed patients in France.

METHODS: A Bayesian Network Meta-Analysis (NMA) determined the comparative efficacy of advanced therapies using a treat-through approach that adjusted maintenance outcomes by the likelihood of clinical response after induction. Efficacy outcomes included the proportion of induction responders with clinical response, clinical remission (both per full Mayo score) or endoscopic improvement after maintenance. Drug acquisition costs over one year were derived from French reimbursement lists, except for upadacitinib 45mg, for which the German published price was used (pre-AMNOG). The CPE was calculated as treatment cost divided by efficacy.

RESULTS: The CPE for clinical remission was €20,556 for upadacitinib (45mg induction, 15mg maintenance), €30,797 for upadacitinib (45mg induction, 30mg maintenance), €75,588 for filgotinib (200mg induction and maintenance), €84,957 for vedolizumab (300mg induction, 300mg Q8W maintenance), €89,259 for tofacitinib (10mg induction, 5mg maintenance), €99,311 for tofacitinib (10mg induction and maintenance), €127,922 for adalimumab (160/80 mg induction, 40mg Q2W maintenance), and €184,771 for ustekinumab (6mg induction, 90 mg Q12W maintenance).

CONCLUSIONS: Upadacitinib has shown to have the lowest cost to achieve a clinical response, clinical remission, and endoscopic improvement, regardless of maintenance dosing regimen. These results may be useful to optimize the therapeutic management of bio-exposed adults with moderately-to-severely active UC in France from a cost-effectiveness point of view.