PGI11 Cost-Effectiveness Analysis of Tofacitinib in the Treatment of Ulcerative Colitis in the Perspective of Brazilian Public Healthcare System

Abstract

Ulcerative colitis is a chronic inflammatory bowel disease whose main characteristic is the recurrent inflammation of the colon mucosa, which begins in the rectum and may extend to other segments of the organ. This analysis proposes to evaluate the cost-effectiveness of tofacitinib, in the treatment of patients with ulcerative colitis from moderate to severe, who have not responded to conventional medicines, in the perspective of Brazilian Ministry of Health. A cost-effectiveness analysis was developed, using a Markov model comparing tofacitinib with the biologic medicines such as infliximab and vedolizumab, considering a lifetime time horizon (for up to 60 years). This analysis considered only direct treatment costs: medicine acquisition, hospitalization, exams and adverse events management. The main outcome of effectiveness measured was QALY gained. The data showed that tofacitinib has better effectiveness and provides a reduction in overall costs when compared to vedolizumab. In comparison to infliximab, tofacitinib is less effective and provides savings in cost. In all the sensitivity analysis developed, the comparisons between tofacitinib and the two biologicals proved to be statistically strong in the cost reduction perspective. In an acceptability analysis the comparison between tofacitinib and vedolizumab and tofacitinib citrate and infliximab showed 100% acceptability, both at a willingness to pay of 1 GDP per capita and 3 GDP per capita settings. The inclusion of tofacitinib in the Brazilian public health system would provide gains, both for the patients, with a safe and effective drug, and to the public healthcare system as a whole, providing significant cost savings when compared to the biological drugs.