Biologic agents are becoming the mainstay of therapy for patients with moderately to severely active Crohn’s Disease (CD). Better understanding of relative costeffectiveness of drugs with new mechanisms of action is needed to help determine the optimal positioning of these therapies in the treatment algorithm and facilitate resource allocation decisions.
OBJECTIVES: A cost-utility analysis was conducted to compare vedolizumab (VDZ) versus ustekinumab (UST) for treatment of patients with moderately to severely active CD from a third-party US payer perspective.
METHODS: A model combining decision-tree and Markov structures was used to predict clinical and economic outcomes at the induction and maintenance phases of treatment. This analysis considered patients who were anti-TNF naïve/non-antiTNF refractory at the time of VDZ/UST treatment initiation within 5-year, 10-year, and lifetime horizon. Efficacy data were derived from a Bayesian network metaanalysis of VDZ and UST phase 3 trials1; other inputs were obtained from published literature. Only direct healthcare costs were considered. Clinical outcomes were expressed as quality-adjusted life-years (QALYs). Univariate and multivariate probabilistic sensitivity analyses (PSA) were conducted to assess model robustness to parameter uncertainty.
RESULTS: Patients treated with VDZ accrued more QALYs than patients treated with UST across all time horizons: 2.479 vs. 2.406 at 5 years, 4.308 vs. 4.220 at 10 years, 10.461 vs. 10.326 in lifetime analysis. The estimated cost difference was also in favor of VDZ: -$51,432 at 5 years, -$52,676 at 10 years, -$55,523 in lifetime analysis. Univariate sensitivity analyses suggested that results are mostly sensitive to treatment response; PSA showed that VDZ is dominant in 89.6% of the simulations.
CONCLUSIONS: The model predicted that VDZ treatment results in a higher number of QALYs gained at lower cost compared with UST in CD patients who had not failed a prior anti-TNF agent. Additional comparative effectiveness studies to confirm these findings are warranted.
