Systematic Review of The Cost-Effectiveness of Medicines For The Treatment of Idiopathic Pulmonary Fibrosis

Abstract

Idiopathic Pulmonary Fibrosis (IPF) is a rare, progressive disease of unknown aetiology with a median survival of 3 years. To date, nintedanib and pirfenidone are the only antifibrotic agents indicated for the treatment of IPF in Western countries. The aim of this study is to conduct a systematic review of the literature on the cost-effectiveness of these two medicines. Search strings with “nintedanib”, “pirfenidone”, “cost-effectiveness”, “cost-utility”, “idiopathic pulmonary fibrosis” and “health technology assessment” terms were entered in PubMed, ISPOR presentations database, EMBASE, ScienceDirect, Cochrane CENTRAL, BIOSIS, Tufts CEA registry, the UK National Institute for Health Research Health Technology Assessment Database, Web of Science and Google. Relevant abstracts, publications and articles in English were collected from inception to June 2017. A total of 12 publications were included in the review. Five studies were conducted in the UK setting, 2 in Canada and Italy, 1 in France, Ireland and Spain. In 10 studies, the perspective was of the National Health Service. Ten studies used a Markov model while 1 other study used a microsimulation model. When compared to best supportive care (BSC), neither nintedanib nor pirfenidone had an incremental cost-effectiveness ratio inferior to €30,000 in any studies except in one which aimed to assess the impact of different models. Seven studies compared nintedanib to pirfenidone. Six of them showed economic dominance of nintedanib over pirfenidone (less costs, more quality-adjusted life years [QALY]), while one showed that pirfenidone was a cost-effective strategy (more QALYs but more costs) compared to nintedanib. Overall, the cost-effectiveness of IPF treatments has been well studied. Nintedanib and pirfenidone have demonstrated important clinical benefits for patients with IPF. Due the lack of alternative treatment, nintedanib and pirfenidone are rarely cost-effective versus BSC. When compared together, nintedanib dominates pirfenidone in most analyses (less costs, more QALYs).