Cost-effectiveness of vedolizumab compared with conventional therapy for ulcerative colitis patients in the UK

Abstract

ObjectiveTo examine the clinical and economic impact of vedolizumab compared with conventional therapy in the treatment of moderately-to-severely active ulcerative colitis (UC) in the UK based on results of the GEMINI I trial.MethodsA decision-analytic model in Microsoft Excel was used to compare vedolizumab with conventional therapy (aminosalicylates, corticosteroids, immunomodulators) for the treatment of patients with UC in the UK. We considered the following three populations: the overall intent-to-treat population from the GEMINI I trial, patients naïve to anti-TNF therapy, and those who had failed anti-TNF-therapy. Population characteristics and efficacy data were obtained from the GEMINI I trial. Other inputs (eg, unit costs, probability of surgery, mortality) were obtained from published literature. Time horizon was a lifetime horizon, with costs and outcomes discounted by 3.5% per year. One-way and probabilistic sensitivity analyses were conducted to measure the impact of parameter uncertainty.ResultsVedolizumab had incremental cost-effectiveness ratios of £4,095/quality-adjusted life-year (QALY), £4,423/QALY, and £5,972/QALY compared with conventional therapy in the intent-to-treat, anti-TNF-naïve, and anti-TNF-failure populations, respectively. Patients on vedolizumab accrued more QALYs while incurring more costs than patients on conventional therapy. The sensitivity analyses showed that the results were most sensitive to induction response and transition probabilities for each treatment.ConclusionThe results suggest that vedolizumab results in more QALYs and may be a cost-effective treatment option compared with conventional therapy for both anti-TNF-naïve and anti-TNF-failure patients with moderately-to-severely active UC.

Cost-Effectiveness Analysis of Vedolizumab Compared with Other Biologics in Anti-TNF-Naïve Patients with Moderate-to-Severe Ulcerative Colitis in Japan

“…Second, previous cost-effectiveness analyses have characterized disease severity during the maintenance phase using three health states, defined by patients' Mayo score: remission (Mayo score 0-2), mild UC (Mayo score 3-5), and moderate-to-severe UC (Mayo score 6-12) [17,18,60]. This approach has been criticized by an independent Evidence Review Group (ERG) during a NICE single technology appraisal of VDZ for the treatment of patients with moderate-to-severe UC in the UK, as this approach ignored that patients in the mild and moderate-to-severe UC health states can include both patients with and without response [61].…”

“…The efficacy and safety of VDZ for the treatment of patients with moderate-to-severe active UC have been demonstrated in an international study, GEMINI I, and a Japanese phase III VDZ study [15,16]. Previous studies have assessed the longterm clinical and economic consequences and cost-effectiveness of VDZ compared with other biologics for the treatment of patients with moderate-to-severe UC in the context of the United Kingdom (UK), Spain, and the United States (US) [17][18][19][20]. However, this information is still unknown in Japan and can be useful for decision makers at the time of repricing biologics for the treatment of patients with moderate-tosevere UC who have not sufficiently responded to CT.…”

Cost-Effectiveness Analysis of Vedolizumab Compared With Infliximab in Anti-TNF-α-Naïve Patients With Moderate-to-Severe Ulcerative Colitis in China

“…To assess the cost effectiveness of vedolizumab vs. infliximab in patients with moderate-to-severe active UC, a hybrid simulation model was used. The model consisted of a decision tree model component for assessing the induction therapy and a Markov model component with lifetime follow-up for assessing the maintenance therapy ( 22 ). In the decision tree model, patients with UC were treated with either infliximab or vedolizumab and evaluated for treatment efficacy after a 6-week induction period.…”

“…Death could occur at any cycle, and patients can transfer to the death state from any other state. After 1 year of treatment with vedolizumab or infliximab, patients who were still in a moderate-to-severe health state were switched to conventional treatment or surgery due to a loss of response ( 22 ). Patients who transferred to surgery would discontinue their current treatment for the remainder of their lifetime.…”

“…Patients who transferred to surgery would discontinue their current treatment for the remainder of their lifetime. Following surgery, these patients could subsequently experience postsurgical complications (i.e., staple line ulcers, anastomotic strictures, pouchitis), require additional surgeries, or remain in postsurgical remission ( 22 ). Patients who responded to the biologic or were in remission but discontinued the drug due to adverse event intolerability were assumed to have switched to conventional therapy during the maintenance phase.…”