Introduction The objective of this analysis was to examine the clinical and economic impact of vedolizumab (VDZ) compared with infliximab (IFX), adalimumab (ADA), and golimumab (GOL) in the treatment of moderately to severely active ulcerative colitis (UC) in the UK (UK).
Methods A Markov decision analytic model in Microsoft Excel was used to compare VDZ with IFX, ADA, and GOL for the treatment of UC patients in the UK. Due to a lack of data in comparable patient populations, this analysis was conducted in anti-tumour necrosis factor (TNF)-naïve patients only. Efficacy data were obtained from a network meta-analysis of Phase III clinical trials, using placebo as the common comparator. Other inputs (e.g., unit costs, adverse event disutilities, probability of surgery, mortality) were obtained from published literature. Costs are presented in 2014 British pounds. Outcomes included quality-adjusted life-years (QALY), time spent in clinical response, and time spent in clinical remission. Time horizons included 10 year (base case) and lifetime (scenario) horizons, with costs and outcomes discounted by 3.5% per year. Incremental cost-effectiveness ratios (ICER) were presented for VDZ compared with other biologics. Univariate and multivariate probabilistic sensitivity analyses were conducted to assess model robustness to parameter uncertainty.
Results Over the base-case (10 year) time horizon, the model predicted that anti-TNF-naïve patients on VDZ accrued more QALY than patients on other biologics: 5.898 QALY vs 5.818, 5.760, and 5.790 QALY for IFX, ADA, and GOL, respectively. The incremental results over a 10 year horizon suggests that VDZ is a cost-effective treatment compared with ADA (ICER of £6,634/QALY), and VDZ is dominant compared with IFX and GOL. Patients on VDZ spent more time in clinical response (2.93 years vs 2.55 years for ADA, IFX and GOL) and clinical remission (1.38 years vs 1.08, 0.99, and 1.04 years for IFX, ADA and GOL respectively). VDZ was found to be dominant compared with all other biologics over a lifetime horizon. Sensitivity analyses suggest that results are most sensitive to treatment response and transition probabilities. However, VDZ remained cost-effective irrespective of variation in any of the input parameters.
Conclusion Our model predicted that treatment with VDZ improves QALY, increases time in remission and response, and is a cost-effective treatment option for anti-TNF-naïve patients with moderately to severely active UC compared with all other biologics tested. VDZ may also be a cost-saving treatment strategy as well.
Disclosure of Interest M. Wilson Conflict with: Employee of RTI Health Solutions, a company hired to conduct the study by Takeda Pharmaceuticals, M. Kerrigan Conflict with: Employee of PHMR Ltd, a company hired to conduct the study by Takeda Pharmaceuticals, M. Smyth Employee of: Takeda Development Centre Europe Ltd, London, UK, H. Chevrou-Severac Employee of: Takeda Pharmaceuticals GmbH, Zurich, Switzerland, A. Bergman Employee of: Takeda Pharmaceuticals GmbH, Zurich, Switzerland, R. Selby Employee of: Takeda UK Ltd., Bucks, UK
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