Cost-effectiveness of the anti-fibrotics for the treatment of idiopathic pulmonary fibrosis in the United States

Abstract

Background The anti-fibrotic medications nintedanib and pirfenidone were approved in the United States for use in patients with idiopathic pulmonary fibrosis several years ago. While there is a growing body of evidence surrounding their clinical effectiveness, these medications are quite expensive and no prior cost-effectiveness analysis has been performed in the United States. Methods A previously published Markov model performed in the United Kingdom was replicated using United States data to project the lifetime costs and health benefits of treating idiopathic pulmonary fibrosis with: (1) symptom management; (2) pirfenidone; or (3) nintedanib. For the cost-effectiveness analysis, strategies were ranked by increasing costs and then checked for dominating treatment strategies. Then an incremental cost-effectiveness ratio was calculated for the dominant therapy. Results The anti-fibrotic medications were found to cost more than $110,000 per year compared to $12,291 annually for symptom management. While pirfenidone was slightly more expensive than nintedanib and provided the same amount of benefit, neither medication was found to be cost-effective in this U.S.-based analysis, with an average cost of $1.6 million to gain one additional quality-adjusted life year over symptom management. Conclusions Though the anti-fibrotics remain the only effective treatment option for patients with idiopathic pulmonary fibrosis and the data surrounding their clinical effectiveness continues to grow, they are not considered cost-effective treatment strategies in the United States due to their high price.

Drug therapies for treatment of idiopathic pulmonary fibrosis: a systematic review, Bayesian network meta-analysis, and cost-effectiveness analysis

“…In addition, Dempsey et al. (2021) 14 suggested that nintedanib and pirfenidone were not considered cost-effective compared with symptom management for IPF in the United States due to their high price.…”

“…Moreover, the costs on drug therapies for IPF are uneven, and some couple with high prices. 14 Due to the irreversible nature of IPF, as well as the multitude of acute exacerbation and hospitalisation that accompany it, a substantial economic burden has been imposed on individuals and overall healthcare resources. 15 , 16 , 17 …”

Cost-Effectiveness of Acthar Gel versus Standard of Care for the Treatment of Advanced Symptomatic Sarcoidosis

“… 45 , 46 FVC% predicted disutilities were sourced from the literature. 47 The utilities were applied based on the scores for each patient in the cycle and were additive. Disutilities were applied to the no response state, assuming progressive disease.…”

Advances in Understanding Fibrosis: Mechanisms, Clinical Implications, Current Therapies, and Prospects for Future Interventions

“…The approval of Nintedanib and Pirfenidone was indeed a breakthrough in treating fibrosis. However, there are currently no generic alternatives, creating a significant financial barrier for use of these therapies in Europe and the United States [143] [144]. Additionally, research into reprogramming, particularly for cardiac fibrosis, is progressing towards clinical application.…”