Abstract
Objective: To evaluate the cost effectiveness of vedolizumab vs. infliximab in the treatment of anti-tumor necrosis factor-alpha (TNF-α)-naïve patients with moderate-to-severe active ulcerative colitis (UC) in China.Methods: The costs and effectiveness of vedolizumab and infliximab in the treatment of anti-TNF-α naïve patients with moderate-to-severe active UC were compared using a hybrid decision tree model and a Markov model. From the perspective of the Chinese healthcare system, this study simulated the lifetime health benefits [quality-adjusted life-years (QALYs)] and costs (USD) for patients with UC from the induction phase to the maintenance phase, with an annual discount rate of 5%. The clinical efficacy and transition probability data were based on a previously published network meta-analysis. The health utility, surgical risk, biologic drug discontinuation rate, and mortality were derived from previous literature and the Chinese statistical yearbook. The cost data were based on China's drug purchase and biding platform and the results of a survey sent to clinicians in 18 tertiary hospitals. One-way and probabilistic sensitivity analyses (PSAs) were performed to validate the robustness of the models' assumptions and specific parameter estimates.Results: The results of the base-case analyses showed that compared with infliximab, vedolizumab led to a gain of 0.25 QALYs (9.56 vs. 9.31 QALYs) and was less expensive by $7,349 ($180,138 vs. 187,487), indicating that the use of vedolizumab was a dominant strategy. The results of one-way sensitivity analyses suggested that the annual discount rate and health-state costs had the greatest impact, but the results were otherwise consistent with those of the base-case analyses. The PSAs suggested that vedolizumab had a 98.6% probability of being effective at a threshold of 3 times the gross domestic product (GDP) per capita in China in 2020.Conclusion: Compared with infliximab, vedolizumab appears to be a more cost-effective option in the treatment of anti-TNF-α naïve adult patients with moderate-to-severe, active UC in China.
Highlights
Ulcerative colitis (UC) is an idiopathic, chronic inflammatory bowel disease (IBD), the cause of which is attributed to the interactions between genetic and epigenetic factors, including microbial factors [1]
The results of the base-case analyses showed that compared with infliximab, vedolizumab led to a gain of 0.25 Quality-adjusted life-years (QALYs) (9.56 vs. 9.31 QALYs) and was less expensive by $7,349 ($180,138 vs. 187,487), indicating that the use of vedolizumab was a dominant strategy
The probabilistic sensitivity analyses (PSAs) suggested that vedolizumab had a 98.6% probability of being effective at a threshold of 3 times the gross domestic product (GDP) per capita in China in 2020
Summary
Ulcerative colitis (UC) is an idiopathic, chronic inflammatory bowel disease (IBD), the cause of which is attributed to the interactions between genetic and epigenetic factors, including microbial factors [1]. It’s reported that approximately 6.8 million patients living with IBD in 2017 [3]. The prevalence of IBD increased from 79.5 per 100,000 persons in 1990 to 84.3 per 100,000 persons in 2017 globally [3]. The highest reported annual incidence and prevalence of UC in Northern Europe were 24.3 per 100,000 person-years and 505 per 100,000 person-years, respectively [2, 4]. The corresponding incidence and prevalence of UC reported in Asia and the Middle East were 6.3 per 100,000 person-years and 168.3 per 100,000 person-years, respectively [4]. Among Chinese UC patients, 69.8% had moderate-to-severe disease [5]
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