COST-EFFECTIVENESS ANALYSIS OF USTEKINUMAB VERSUS ADALIMUMAB, INFLIXIMAB AND VEDOLIZUMAB FOR THE TREATMENT OF PATIENTS WITH MODERATELY TO SEVERE ACTIVE CROHN’S DISEASE FOR TURKEY
Author(s)
Arhan M1, Tezel HA2, Toruner M3, Bilaloğlu B4, Koral S4, Ozer E4
1Gazi University, Ankara, Turkey, 2Trakya University, Edirne, Turkey, 3Ankara University, Ankara, Turkey, 4Janssen Pharmaceuticals, Johnson and Johnson Ltd., Istanbul, Turkey
OBJECTIVES:
- To evaluate the cost-effectiveness of Ustekinumab compared to available biologic treatments (adalimumab [ADA], infliximab [INF] and vedolizumab [VED]) in the treatment of adult patients with moderately to severely active Crohn’s disease who have failed or are intolerant to conventional treatment or a tumour-necrosis-factor (TNFα) antagonist.
- A life time horizon Markov model representing the transitions of active Crohn’s disease patients among four health states (remission, mild, moderate/severe and surgery) depending on their response status, was adapted to Turkey.
- Clinical inputs were derived from published results of the clinical trials of all treatment options.
- The analysis was undertaken from payer’s perspective. Only direct local costs such as medication, administration, surgical procedures, surgical complications, monitoring and side effects were taken into account.
- Incremental Cost-effectiveness Ratio (ICER) per quality-adjusted-life-years (QALY) gained were calculated.
- American dollars were used as the currency unit based on the Purchasing Power Parity (PPP) (1USD*=1.38TL-OECD 2017).
- Willingness-to-pay (WTP) threshold was set as three times the local gross domestic product per capita adjusted by PPP (76,965 PPP-USD as of 2018).
- In conventional treatment failure/intolerance population (with 3 years of treatment); QALY gained with Ustekinumab was 0.118 and 0.312 years longer than ADA and INF (23.81, 23.69 and 23.49 years, respectively). ICERs against ADA and INF were calculated as 56,509 PPP-USD/QALY and 44,349 PPP-USD /QALY, respectively.
- In TNFα antagonist failure/intolerance population; QALY gained with Ustekinumab was 0.158 years longer than VED (24.39 years vs 24.23 years), while providing a cost-saving of 872 PPP-USD.
- Ustekinumab has been determined to be cost-effective against ADA and INF; while with more QALY and less cost, it has been determined to be the dominant treatment option compared with VED.
Conference/Value in Health Info
2018-11, ISPOR Europe 2018, Barcelona, Spain
Value in Health, Vol. 21, S3 (October 2018)
Code
PGI21
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Gastrointestinal Disorders