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Cost Effectiveness and Resource Allocation
Published in: Cost Effectiveness and Resource Allocation 1/2018

Open Access 01-12-2018 | Research

Cost-effectiveness of ustekinumab in moderate to severe Crohn’s disease in Sweden

Authors: Amanda Hansson-Hedblom, Chrissy Almond, Fredrik Borgström, Indeg Sly, Dana Enkusson, Anders Troelsgaard Buchholt, Linda Karlsson

Published in: Cost Effectiveness and Resource Allocation | Issue 1/2018

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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.
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Metadata
Title
Cost-effectiveness of ustekinumab in moderate to severe Crohn’s disease in Sweden
Authors
Amanda Hansson-Hedblom
Chrissy Almond
Fredrik Borgström
Indeg Sly
Dana Enkusson
Anders Troelsgaard Buchholt
Linda Karlsson
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Cost Effectiveness and Resource Allocation / Issue 1/2018
Electronic ISSN: 1478-7547
DOI
https://doi.org/10.1186/s12962-018-0114-y

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