Cost-effectiveness of ustekinumab in moderate to severe Crohn’s disease in Sweden
Abstract Background 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. Methods A cost-effectivene...
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| Format: | Article |
| Language: | English |
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BMC
2018-08-01
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| Series: | Cost Effectiveness and Resource Allocation |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12962-018-0114-y |
| _version_ | 1818957151660408832 |
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| author | Amanda Hansson-Hedblom Chrissy Almond Fredrik Borgström Indeg Sly Dana Enkusson Anders Troelsgaard Buchholt Linda Karlsson |
| author_facet | Amanda Hansson-Hedblom Chrissy Almond Fredrik Borgström Indeg Sly Dana Enkusson Anders Troelsgaard Buchholt Linda Karlsson |
| author_sort | Amanda Hansson-Hedblom |
| collection | DOAJ |
| description | Abstract Background 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. Methods 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). Results 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. Conclusions Results indicate ustekinumab dominates adalimumab in conventional care failure population, and is cost-effective versus vedolizumab in TNF-alpha-inhibitor failure population. |
| first_indexed | 2024-12-20T11:05:18Z |
| format | Article |
| id | doaj.art-77378702b6df4fb88d92e17e7b5c6340 |
| institution | Directory Open Access Journal |
| issn | 1478-7547 |
| language | English |
| last_indexed | 2024-12-20T11:05:18Z |
| publishDate | 2018-08-01 |
| publisher | BMC |
| record_format | Article |
| series | Cost Effectiveness and Resource Allocation |
| spelling | doaj.art-77378702b6df4fb88d92e17e7b5c63402022-12-21T19:42:52ZengBMCCost Effectiveness and Resource Allocation1478-75472018-08-0116111210.1186/s12962-018-0114-yCost-effectiveness of ustekinumab in moderate to severe Crohn’s disease in SwedenAmanda Hansson-Hedblom0Chrissy Almond1Fredrik Borgström2Indeg Sly3Dana Enkusson4Anders Troelsgaard Buchholt5Linda Karlsson6Quantify Research ABBresMedQuantify Research ABBresMedJanssen-Cilag ABJanssen-Cilag ABQuantify Research ABAbstract Background 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. Methods 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). Results 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. Conclusions Results indicate ustekinumab dominates adalimumab in conventional care failure population, and is cost-effective versus vedolizumab in TNF-alpha-inhibitor failure population.http://link.springer.com/article/10.1186/s12962-018-0114-yCrohn’s diseaseUstekinumabAdalimumabVedolizumabCost-effectiveness |
| spellingShingle | Amanda Hansson-Hedblom Chrissy Almond Fredrik Borgström Indeg Sly Dana Enkusson Anders Troelsgaard Buchholt Linda Karlsson Cost-effectiveness of ustekinumab in moderate to severe Crohn’s disease in Sweden Cost Effectiveness and Resource Allocation Crohn’s disease Ustekinumab Adalimumab Vedolizumab Cost-effectiveness |
| title | Cost-effectiveness of ustekinumab in moderate to severe Crohn’s disease in Sweden |
| title_full | Cost-effectiveness of ustekinumab in moderate to severe Crohn’s disease in Sweden |
| title_fullStr | Cost-effectiveness of ustekinumab in moderate to severe Crohn’s disease in Sweden |
| title_full_unstemmed | Cost-effectiveness of ustekinumab in moderate to severe Crohn’s disease in Sweden |
| title_short | Cost-effectiveness of ustekinumab in moderate to severe Crohn’s disease in Sweden |
| title_sort | cost effectiveness of ustekinumab in moderate to severe crohn s disease in sweden |
| topic | Crohn’s disease Ustekinumab Adalimumab Vedolizumab Cost-effectiveness |
| url | http://link.springer.com/article/10.1186/s12962-018-0114-y |
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