Cost-utility of biological treatment sequences for luminal Crohn's disease in Europe.

Abstract

BACKGROUND:

This study aims to compare the cost-effectiveness of treatment sequences with available biologics, including adalimumab (ADA), biosimilar infliximab (bsIFX), originator infliximab (IFX) and vedolizumab (VEDO) for luminal Crohn's disease in nine European countries.

METHODS:

A Markov-model was constructed to simulate five-year medical costs and quality-adjusted life years (QALYs). Data on clinical efficacy were obtained from randomised controlled trials. Country-specific unit costs, discount rates and a third-party payer perspective were applied.

RESULTS:

The bsIFX versus conventional therapy resulted in the most favourable incremental cost-utility ratios (ICURs) ranging from €34,580 (Hungary) to €77,062/QALY (Sweden). Compared to bsIFX, the bsIFX-ADA sequence was more cost-effective than the bsIFX-VEDO sequence with ICURs varying between €70,277 (France) and €162,069/QALY (Germany). The ICURs of the bsIFX-ADA-VEDO sequence versus the bsIFX-ADA strategy were between €206,266 (The Netherlands) and €363,232/QALY (Spain).

CONCLUSION:

We are the first to compare cost-effectiveness of multiple biological sequences for luminal Crohn's disease. Based on our findings, bsIFX can be recommended as a first-line treatment in patients unresponsive to conventional treatments. While biological sequences only slightly differ in their associated health gains, their costs vary greatly. The bsIFX-ADA-VEDO seems to be the most cost-effective sequence of the available biologics across Europe.

• Authors: Fanni Rencz, László Gulácsi, Márta Péntek, Krisztina B Gecse, Axel Dignass, Jonas Halfvarson, Fernando Gomollón, Petra Baji, Laurent Peyrin-Biroulet, Peter L Lakatos, Valentin Brodszky
• Journal: Expert review of pharmacoeconomics & outcomes research (Expert Rev Pharmacoecon Outcomes Res) Vol. 17 Issue 6 Pg. 597-606 (Dec 2017) ISSN: 1744-8379 [Electronic] England
• PMID: 28434387 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Antibodies, Monoclonal, Humanized
• Biosimilar Pharmaceuticals
• Gastrointestinal Agents
• vedolizumab
• Infliximab
• Adalimumab

Topics

• Adalimumab (administration & dosage, economics, therapeutic use)
• Antibodies, Monoclonal, Humanized (administration & dosage, economics, therapeutic use)
• Biosimilar Pharmaceuticals (administration & dosage, economics, therapeutic use)
• Cost-Benefit Analysis
• Crohn Disease (drug therapy, economics)
• Drug Administration Schedule
• Drug Therapy, Combination
• Europe
• Gastrointestinal Agents (administration & dosage, economics, therapeutic use)
• Humans
• Infliximab (administration & dosage, economics, therapeutic use)
• Markov Chains
• Models, Economic
• Quality-Adjusted Life Years
• Randomized Controlled Trials as Topic