OBJECTIVES: Idiopathic Pulmonary Fibrosis (IPF) is a debilitating lung disease consisting in an irreversibly declining lung function over time. The median survival after diagnosis is 2–3 years. In Belgium, nintedanib and pirfenidone are the only available treatments for the treatment of IPF. This study aims to compare the cost-utility of nintedanib versus pirfenidone in the Belgian setting.

METHODS: We adapted a previously developed Markov model to the Belgian National Health System perspective, simulating a hypothetical cohort of IPF patients followed up over a lifetime span. Relative effectiveness between the products was calculated from a network meta-analysis using data from each pivotal trial. The baseline risk of each event was estimated from the control arm of nintedanib clinical trials (TOMORROW, INPULSIS-1, INPULSIS-2). Mortality, loss of lung function and acute exacerbations were used for efficacy outcomes, serious adverse events were used for toxicity while overall discontinuation was used for tolerability. An annual discount rate of 3% and 1.5% were set for costs and health benefits, respectively. Deterministic and probabilistic sensitivity analyses tested the impact of alternate efficacy and safety outcomes, costs and utility values. We used Belgian data reported in 2018 euros as cost inputs.

RESULTS: Nintedanib yielded more quality-adjusted life years (QALY) than pirfenidone (3.9445 QALY vs. 3.8793 QALY, respectively) and lower total costs (€7,620 less) mainly due to fewer acute exacerbations and lower treatment costs, making nintedanib a dominant option over pirfenidone due to better effectiveness and lower costs. Probabilistic sensitivity analysis shows that nintedanib is more cost-effective than pirfenidone with a probability of 95.0% at a willingness to pay of €30.000/QALY. Even if pirfenidone price was decreased by 20%, nintedanib would still dominate pirfenidone.

CONCLUSIONS: Both nintedanib and pirfenidone have demonstrated important clinical benefits for IPF patients. In the Belgian setting, nintedanib dominates pirfenidone (less costs, more QALYs).