Cost-utility analysis of infliximab and adalimumab for refractory ulcerative colitis
ObjectiveTo evaluate cost-utility of infliximab and adalimumab for treatment of moderate-to-severe UC refractory to conventional therapies in Canada.
Methods: A Markov model was constructed to evaluate incremental cost-utility ratios (ICUR) of 5 mg/kg and 10 mg/kg infliximab and adalimumab compared to usual care in treating a hypothetical cohort of patients (aged 40 years and weighed 80 kg) over a five-year time horizon from the perspective of a publicly-funded health care system. Clinical parameters were derived from the Active Ulcerative Colitis Trials 1 and 2.
Costs were obtained through provincial drug benefit plans. ICUR was the main outcome measure and both deterministic and probabilistic sensitivity analyses were conducted.
Results: Compared to the strategy A ("usual care") in the base case analysis, the ICURs were CA$358,088/QALY for the strategy B ("5mg/kg infliximab + adalimumab") andCA$575,540/QALY for the strategy C ("5mg/kg and 10mg/kg infliximab + adalimumab").
The results were sensitive to the remission rates maintained in responders to usual care and to 5 mg/kg infliximab, the rate of remission induced by adalimumab in nonresponders to 5 mg/kg infliximab, early surgery rate, and utility values. When the willingness to pay (WTP) was less than CA$150,000/QALY, the probability of usual care being the optimal strategy was 1.0.
The probability of strategy B being optimal was 0.5 when the WTP approximated CA$400,000/QALY.
Conclusions: The ICURs of anti-TNF-alpha drugs were not satisfactory in treating patients with moderate-to-severe refractory UC. Future research could be aimed at the long-term clinical benefits of these drugs, especially adalimumab for patients intolerance or failed infliximab treatment.
Author: Feng XieGord BlackhouseNazila AssaiKathryn GaebelDiana RobertsonRon Goeree
Credits/Source: Cost Effectiveness and Resource Allocation 2009, 7:20
Published on: 2009-12-11
Copyright by the authors listed above - made available via BioMedCentral (Open Access). Please
make sure to read our disclaimer prior to contacting 7thSpace Interactive. To contact our editors, visit our online helpdesk. If you wish submit your own press release, click here.
Social Bookmarking
RETWEET This! | Digg this! | Post to del.icio.us | Post to Furl | Add to Netscape | Add to Yahoo! | Rojo
|
|
