Cost per Responder Analysis of Filgotinib in Patients Suffering from Ulcerative Colitis

Abstract

OBJECTIVE: To evaluate the costs and benefits associated with the use of biologics and Janus kinase inhibitors (JAKi) for the treatment of bio-experienced patients suffering from ulcerative colitis in Italy.METHODS: This pharmacoeconomic analysis compared JAKi (filgotinib, tofacitinib and upadacitinib) and biologics (vedolizumab and ustekinumab). A decision tree model with a 1-year time horizon was built in MS Excel in order to estimate treatment cost and clinical efficacy expressed in terms of clinical response (CR), clinical remission (CRe) and mucosal healing (MH). Efficacy of each treatment was estimated using relative risks elaborated from a recent network meta-analysis of 17 RCTs. The investigated population concerned patients previously treated with biologic drugs (bio-experienced). Both induction and maintenance phases were considered and dose escalation (when allowed) was planned for patients not reaching an appropriate response after induction. Outcomes included total treatment cost (acquisition and administration), overall response rate, and cost per responder at one year.RESULTS: According to the model results, the treatment associated with the best clinical response at 1 year was vedolizumab (69.6%) followed by filgotinib (60.9%) and upadacitinib (60.1%). Despite differences in efficacy, filgotinib resulted in the lowest cost per responder, in every outcome, compared with all the other alternatives. The same trend applies when observing results at the end of the induction phase only. Results were robust to probabilistic sensitivity analyses, filgotinib has a posterior probability to be better than the other alternatives higher than 96% according to all the three response definitions (CR, CRe, and MH).CONCLUSIONS: Generally, JAKis and vedolizumab were associated with higher treatment response. Among the alternatives included in the analysis, filgotinib has the lowest cost per responder for all the outcomes included. These findings could help deliver more effective and efficient healthcare in the NHS.