Fanni Rencz1, László Gulácsi1, Márta Péntek1, Krisztina B Gecse2, Axel Dignass3, Jonas Halfvarson4, Fernando Gomollón5, Petra Baji1,6, Laurent Peyrin-Biroulet7, Peter L Lakatos2, Valentin Brodszky1. 1. a Department of Health Economics , Corvinus University of Budapest , Budapest , Hungary. 2. b 1st Department of Medicine , Semmelweis University , Budapest , Hungary. 3. c Department of Medicine 1 , Agaplesion Markus Krankenhaus , Frankfurt , Germany. 4. d Department of Gastroenterology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden. 5. e Gastroenterology Unit , Clinical Universitary Hospital Lozano IIS Aragón (Blesa, IIS Aragón, CIBEREHD) , Zaragoza , Spain. 6. f Center for Economic Research and Graduate Education (CERGE) Economics Institute (EI) Research Fellow , Charles University , Praha 1 , The Czech Republic. 7. g Inserm U954 and Department of Hepato-Gastroenterology, University Hospital of Nancy-Brabois , Lorraine University , Vandoeuvre-lès-Nancy , France.
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.
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: Frank I Scott; Michelle Luo; Yash Shah; Karen Lasch; Ravy K Vajravelu; Ronac Mamtani; Blair Fennimore; Mark E Gerich; James D Lewis Journal: J Crohns Colitis Date: 2020-06-19 Impact factor: 9.071