A Markov Model Evaluating the Cost-Effectiveness of Ustekinumab Compared to Vedolizumab for patient's with Crohn’s Disease as Third-Line Therapy

Abstract Background Clinical management of skin-toxicity associated with the use of anti-Epidermal Growth Factor Receptor (EGFR) antibodies to treat colorectal cancer maintains quality of life of patients with colorectal cancer. Results of clinical trials have recommended the efficacy of prophylactic treatment, but the cost-effectiveness is unclear. This study examined the cost-effectiveness of preventive skin care for skin-toxicity caused by panitumumab in third-line therapy for KRAS wild type metastatic colorectal cancer from the perspective of the Japanese healthcare payer. Methods The data source was J-STEPP trial, which compared preemptive skin treatment with reactive treatment in third-line panitumumab therapy for KRAS wild type metastatic colorectal cancer in Japan. The costs and effectiveness of preemptive treatment was compared with reactive treatment in a 3-year time horizon using a 4-state partitioned survival analysis. The health outcome was quality-adjusted life-years (QALYs). The costs were 2020 revisions to the drug prices. The robustness of the model was verified by one-way sensitivity analysis and a probabilistic sensitivity analysis (PSA). A 2% annual discount was applied to the expenses and QALYs. Willingness-to-pay (WTP) threshold of 5 million JPY was used. Results Preemptive treatment had incremental effects of 0.0029 QALYs, incremental costs of 5300 JPY (48.6 USD), and incremental cost-effectiveness ratios (ICER) of 1,843,395 JPY (16,912 USD) per QALY. The variability of preemptive and reactive treatment costs for skin-toxicity and the disutility of skin-toxicity had a large impact on ICER. From PSA, the cost-effectiveness rate of preemptive treatment was 75.0%. Conclusions The cost to effectiveness of preemptive treatment to prevent skin-toxicity caused by panitumumab in third-line therapy for KRAS wild type mCRC is not high.

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P239 Methotrexate as a third-line therapy after thiopurine and anti-TNF failure in Crohn's disease

Journal of Crohn s and Colitis ◽

10.1016/s1873-9946(12)60259-1 ◽

2012 ◽

Vol 6 ◽

pp. S104-S105 ◽

Cited By ~ 2

Author(s):

W. Diaz-Saa ◽

D. Carpio-Lopez ◽

E. Fernandez-Salgado ◽

M.V. Alvarez-Sanchez ◽

S. Vazquez-Rodriguez ◽

...

Keyword(s):

Crohn’S Disease ◽

Crohn's Disease ◽

Line Therapy ◽

Third Line Therapy ◽

Third Line

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Cost-Effectiveness of Third-Line Anti-TNF Therapy Compared to Natalizumab in Patients With Moderate-to-Severe Crohn's Disease With Two Prior Anti-TNF Failures

Gastroenterology ◽

10.1016/s0016-5085(11)63233-2 ◽

2011 ◽

Vol 140 (5) ◽

pp. S-780

Author(s):

Ashwin N. Ananthakrishnan ◽

Chin Hur ◽

Joshua R. Korzenik

Keyword(s):

Crohn’S Disease ◽

Cost Effectiveness ◽

Crohn's Disease ◽

Third Line

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Evaluating the Cost-Effectiveness of Early Compared with Late or No Biologic Treatment to Manage Crohn’s Disease using Real-World Data

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz169 ◽

2019 ◽

Vol 14 (4) ◽

pp. 490-500 ◽

Cited By ~ 4

Author(s):

Nadia Pillai ◽

Judith E Lupatsch ◽

Mark Dusheiko ◽

Matthias Schwenkglenks ◽

Michel Maillard ◽

...

Keyword(s):

Crohn’S Disease ◽

Cost Effectiveness ◽

Crohn's Disease ◽

Health System ◽

Real World ◽

Transition Probabilities ◽

Cost Effective ◽

Real World Data ◽

World Data ◽

The Cost

Abstract Background and Aims We evaluated the cost-effectiveness of early [≤2 years after diagnosis] compared with late or no biologic initiation [starting biologics >2 years after diagnosis or no biologic use] for adults with Crohn’s disease in Switzerland. Methods We developed a Markov cohort model over the patient’s lifetime, from the health system and societal perspectives. Transition probabilities, quality of life, and costs were estimated using real-world data. Propensity score matching was used to ensure comparability between patients in the early [intervention] and late/no [comparator] biologic initiation strategies. The incremental cost-effectiveness ratio [ICER] per quality-adjusted life year [QALY] gained is reported in Swiss francs [CHF]. Sensitivity and scenario analyses were performed. Results Total costs and QALYs were higher for the intervention [CHF384 607; 16.84 QALYs] compared with the comparator [CHF340 800; 16.75 QALYs] strategy, resulting in high ICERs [health system: CHF887 450 per QALY; societal: CHF449 130 per QALY]. In probabilistic sensitivity analysis, assuming a threshold of CHF100 000 per QALY, the probability that the intervention strategy was cost-effective was 0.1 and 0.25 from the health system and societal perspectives, respectively. In addition, ICERs improved when we assumed a 30% reduction in biologic prices [health system: CHF134 502 per QALY; societal: intervention dominant]. Conclusions Early biologic use was not cost-effective, considering a threshold of CHF100 000 per QALY compared with late/no biologic use. However, early identification of patients likely to need biologics and future drug price reductions through increased availability of biosimilars may improve the cost-effectiveness of an early treatment approach.

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The Cost-effectiveness of Biological Therapy Cycles in the Management of Crohn’s Disease

Journal of Crohn s and Colitis ◽

10.1093/ecco-jcc/jjz063 ◽

2019 ◽

Vol 13 (10) ◽

pp. 1323-1333 ◽

Cited By ~ 4

Author(s):

Kristian Bolin ◽

Erik Hertervig ◽

Edouard Louis

Keyword(s):

Crohn’S Disease ◽

Cost Effectiveness ◽

Crohn's Disease ◽

Combination Therapy ◽

Willingness To Pay ◽

Cost Effective ◽

Treatment Intensification ◽

Tree Model ◽

Necrosis Factor Alpha ◽

The Cost

Abstract Objectives To examine the cost-effectiveness of continued treatment for patients with moderate-severe Crohn’s disease in clinical remission, with a combination of anti-tumour necrosis factor alpha [anti-TNFα] [infliximab] and immunomodulator therapy compared with two different withdrawal strategies: [1] withdrawal of the anti-TNFα therapy; and [2] withdrawal of the immunomodulator therapy, respectively. Methods A decision-tree model was constructed mimicking three treatment arms: [1] continued combination therapy with infliximab and immunomodulator; [2] withdrawal of infliximab; or [3] withdrawal of the immunomodulator. Relapses in each arm are managed with treatment intensification and re-institution of the de-escalated drug according to a prespecified algorithm. State-dependent relapse risks, remission probabilities, and quality of life weights were collected from previous published studies. Results Combination therapy was less costly and more efficient than the withdrawal of the immunomodulator, and more costly and more efficient than withdrawal of infliximab. Whether or not combination therapy is cost-effective, compared with the alternatives, depends primarily on current pharmaceutical prices and the willingness-to-pay per additional quality-adjusted life-year [QALY]. Conclusions Combination therapy using a combination of anti-TNFα [infliximab] and an immunomodulator is cost-effective in the treatment of Crohn’s disease compared with treatment cycles in which the immunomodulator is withdrawn. Combination treatment is cost-effective compared with treatment cycles in which infliximab is withdrawn, at prices of infliximab below€192/100 mg, given a willingness-to-pay threshold at€49 020 [Sweden] per additional QALY.

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Abiraterone vs. docetaxel for metastatic hormone-sensitive prostate cancer: A microsimulation model

Canadian Urological Association Journal ◽

10.5489/cuaj.6234 ◽

2019 ◽

Vol 14 (9) ◽

Author(s):

Amanda E. Hird ◽

Diana E. Magee ◽

Douglas C. Cheung ◽

Rano Matta ◽

Girish S. Kulkarni ◽

...

Keyword(s):

Prostate Cancer ◽

Cost Effectiveness ◽

Adverse Events ◽

De Novo ◽

Microsimulation Model ◽

Line Therapy ◽

Life Years ◽

Cost Effective Treatment ◽

Third Line Therapy ◽

Third Line

Introduction: Our aim was to determine whether androgen-deprivation therapy (ADT) with abiraterone acetate (AA) or ADT with docetaxel chemotherapy (DC) resulted in improved quality-adjusted life years (QALYs) among men with de novo metastatic castration-sensitive prostate cancer (mCSPC) and the cost-effectiveness of the preferred strategy using decision analytic techniques. Methods: A microsimulation model with a lifetime time horizon was constructed. Our primary outcome was QALYs. Secondary outcomes included cost, incremental cost-effectiveness ratio (ICER), unadjusted overall survival (OS), rates of second- and third-line therapy, and adverse events. A systematic literature review was used to generate probabilities and utilities to populate the model. The base case was a 65-year-old patient with de novo mCSPC. Results: A total of 100 000 microsimulations were generated. Initial AA resulted in a gain of 0.45 QALYs compared to DC (3.36 vs. 2.91 QALYs) with an ICER of $276 251.84 per QALY gained with initial AA therapy. Median crude OS was 51 months with AA and 48 months with DC. Overall, 46.6% and 42.6% of patients received second-line therapy and 8.7% and 7.9% patients received third-line therapy in the AA and DC groups, respectively. Grade 3/4 adverse events were experienced in 17.6% of patients receiving initial AA and 22.3% of patients receiving initial DC. Conclusions: Although ADT with AA results in a gain in QALYs and crude OS compared to DC, AA therapy is not a cost-effective treatment strategy to apply uniformly to all patients. The availability of AA as a generic medication may help to close this gap. The ultimate choice should be based on patient and tumor factors.

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