Cost-effectiveness of ustekinumab in moderate to severe Crohn's disease in Sweden

• Published in: Cost effectiveness and resource allocation 2018-08, Vol.16 (1), p.28-28, Article 28
• Main Authors: Hansson-Hedblom, Amanda, Almond, Chrissy, Borgström, Fredrik, Sly, Indeg, Enkusson, Dana, Troelsgaard Buchholt, Anders, Karlsson, Linda
• Format: Article
• Language: English
• Subjects: Adalimumab; Comparative analysis; Contraindications; Cost analysis; Cost-effectiveness; Crohn's disease; Cytokines; Decision trees; Economic aspects; Immunotherapy; Inflammatory bowel disease; Interleukins; Lymphoma; Medicin och hälsovetenskap; Monoclonal antibodies; Patients; Pharmaceuticals; Population; Quality of life; Remission (Medicine); Standard of care; Studies; Surgery; Systematic review; TNF inhibitors; Tumor necrosis factor; Ustekinumab; Vedolizumab
• ISSN: 1478-7547; 1478-7547
• DOI: 10.1186/s12962-018-0114-y

Human monoclonal antibody ustekinumab is a novel Crohn's disease (CD) treatment blocking pro-inflammatory cytokines interleukin-12 and 23. The study's objective was to assess cost-effectiveness of ustekinumab in moderate to severely active CD in Sweden. A cost-effectiveness model with an induction phase decision-tree structure and a maintenance phase Markov cohort structure was constructed. CD was represented by five health-states: remission, mild, moderate-severe, surgery and death. Ustekinumab was compared to adalimumab in patients who had failed conventional care, some of which had tried TNF-alpha-inhibitor(s) without experiencing treatment failure or side effects ("conventional care failure population") and to vedolizumab in patients previously failing TNF-alpha-inhibitor treatment. Discontinuation probabilities, utilities and ustekinumab induction efficacy were sourced from phase-III trials. Maintenance and comparator efficacy came from network-meta and treatment-sequence analyses. Resource use and unit costs were derived from literature and validated by clinical experts. The analysis had a societal perspective, a life-time time-horizon, and 2-year treatment duration. The results robustness was tested in univariate and probabilistic sensitivity analyses. Cost-effectiveness was estimated using quality-adjusted life-years (QALYs). Ustekinumab dominated adalimumab in conventional care failure population (costs: - €6984, QALYs: + 0.232). In TNF-alpha-inhibitor failure population ustekinumab accrued 0.133 more QALYs than vedolizumab, yielding a €30,282 incremental cost-effectiveness ratio. Results were sensitive to decreasing the time horizon and increased treatment duration. At Swedish reference willingness-to-pay of €63,000 (SEK 600,000), ustekinumab had 94% probability of being cost-effective versus adalimumab, and 72% versus vedolizumab. Results indicate ustekinumab dominates adalimumab in conventional care failure population, and is cost-effective versus vedolizumab in TNF-alpha-inhibitor failure population.