PGI23 - COST-EFFECTIVENESS ANALYSIS OF PARENTERAL METHOTREXATE FOR THE TREATMENT OF CROHN’S DISEASE IN THE CZECH REPUBLIC

Abstract

Clinical evidence suggests that parenteral methotrexate (MTX) provides benefit for induction of remission and complete discontinuation of high-dose oral corticosteroid treatment (hdCS; >20mg/day) in patients with Crohn’s disease (CD). Our aim was to assess cost-effectiveness of MTX in the treatment of mild-to-moderate CD in comparison to hdCS/placebo with its gradual withdrawal in the Czech Republic. We developed a three-year Markov model with one-week cycle length in TreeAge. The model comprises four health states – initial state of mild-to-moderate CD (16-week treatment with MTX or hdCS), steroid-free remission, lack/loss of response and death. It projects quality-adjusted life-years (QALYs) and costs from healthcare payers’ perspective. Costs were based on list prices, reimbursement tariffs and previous pharmacoeconomic analyses as of 02/2018. Costs and outcomes were discounted by 3%. Transition probabilities between health states were provided by clinical trials and extrapolated using survival analysis. Mortality rate was taken from Czech mortality tables and adjusted to CD. Utilities were derived from the published mapping algorithm. One-way sensitivity analysis (OWSA) accompanied by scenario analysis (SA) was performed. Probability sensitivity analysis (PSA; 10,000 iterations) was run using an implicit willingness-to-pay threshold (WTP) of €47,000/QALY. Over a three-year time horizon, MTX yields additional 0.06 QALYs (1.92 vs. 1.86) at the additional total cost of €761 (€2263 vs. €1503) compared with hdCS, with the incremental cost-effectiveness ratio of €13,077/QALY. PSA showed that probability of MTX to be cost-effective was 99.89% at the WTP. OWSA and SA confirmed the robustness of the base-case result with all one-way changes and scenarios deeply below WTP. Parenteral MTX is a cost-effective therapy for patients with mild-to-moderate CD receiving hdCS. Therefore, it was swiftly and positively assessed by the local authority. To our knowledge, this is the first published cost-effectiveness analysis of parenteral MTX for this indication.