OBJECTIVES: Vedolizumab is a gut‐selective anti‐lymphocyte trafficking biologic indicated for the treatment of adult patients with moderately to severely active ulcerative colitis (UC) and Crohn’s disease (CD) in Canada. The objective of this study was to evaluate the cost-effectiveness of treatment sequencing for UC and CD from a public payer perspective leveraging new real-world data from the literature and EVOLVE study.

METHODS: Using separate published decision tree/Markov models for UC and CD, cost-effectiveness of two sequencing approaches was estimated for adult patients (> 18 years) diagnosed with UC and CD who are biologic-naïve: vedolizumab as first-line biologic followed by anti-TNF vs. first-line anti-TNF followed by vedolizumab. Treatment effectiveness (response and remission), surgery rates, dose escalation and regain of response and safety inputs were taken from EVOLVE, a retrospective chart review of real-world data, and randomized clinical trials, whereas costs and utilities were from HTA reports and the literature. Biosimilar costs were used for the anti-TNFs. Both models simulated a lifetime horizon and discounted outcomes at 1.5%. Probabilistic base-case analyses (n=10,000) reported total costs (Canadian dollars), and quality-adjusted life years (QALYs).

RESULTS: In UC, vedolizumab as first-line biologic followed by anti-TNF resulted in an incremental gain of 0.05 QALYs (14.16 vs. 14.11) and saved $13,377 ($453,025 vs. $466,401), making this a dominant strategy compared to first-line anti-TNF. In CD, first-line vedolizumab use resulted in an incremental gain of 0.02 QALYs (16.59 vs. 16.57) at an incremental cost of $5,691 ($451,245 vs. $445,554) versus first-line anti-TNF. In CD, probabilistic sensitivity analysis estimated that first-line vedolizumab use may be cost-effective at a $125,000/QALY cost-effectiveness threshold.

CONCLUSIONS: In Canada, sequencing vedolizumab as a first-line biologic prior to anti-TNF in UC provides additional clinical value and saves costs compared to anti-TNFs. In CD, vedolizumab as first-line biologic resulted in additional health benefits at marginal costs.