OBJECTIVE: To estimate the cost-effectiveness of vedolizumab (VDZ) compared with ustekinumab (UST) in the treatment of patients with moderately to severely active Crohn’s disease (CD) who have previously failed tumor necrosis factor alfa inhibitors (anti-TNFs) in the United Kingdom (UK).
METHODS: A two-part decision-analytic model (1-year decision tree and post-1-year Markov model) was developed in Microsoft Excel to compare VDZ with UST for the treatment of CD patients in the UK who previously failed anti-TNF treatment. The model time horizon was 5, 10, and 30 years. Population characteristics and efficacy data were derived from clinical trial data for both treatments. Other inputs (e.g., costs, utilities, surgery risk, mortality, etc.) came from published literature. Costs (in 2017 GBP) and quality-adjusted life-years (QALY), surgeries, and years in remission were estimated and discounted by 3.5% annually. Incremental cost per QALY gained was estimated to determine cost-effectiveness. One-way sensitivity analyses and probabilistic sensitivity analyses (PSA) were conducted to assess model robustness to parameter uncertainty.
RESULTS: VDZ patients accrued 2.348, 3.997, and 8.111 over 5, 10, and 30 years respectively. Comparatively, 12-weekly UST patients received 2.341, 3.980, and 8.091 QALYs over the same time horizons. Findings were similar for surgeries (VDZ patients incurred fewer) and years in remission (VDZ patients accrued more). VDZ patients also incurred lower costs than UST patients (savings of £643 to £1,253), making VDZ the dominant treatment strategy compared with UST. Results were most sensitive to treatment response in induction. In the PSA, VDZ was dominant compared with UST in 50.18% and cost-effective in 62.26% of simulations.
CONCLUSIONS: Our model predicted that treatment with VDZ improves QALY, increases time in remission, reduces surgeries, and is a cost-saving strategy compared with UST for anti-TNF failure patients with moderately to severely active CD in the UK.
