ECONCARE LP.
Pfizer Hellas, Athens, Greece.
Eur J Gastroenterol Hepatol. 2021 Mar 1;33(3):325-333. doi: 10.1097/MEG.0000000000001916.
To evaluate the cost-effectiveness of tofacitinib versus other treatment options currently available for the management of adult patients with moderate-to-severe ulcerative colitis, who have had an inadequate response, loss of response, or were intolerant to conventional therapy or a biologic agent, in Greece.
A Markov model was adapted for projecting lifetime costs and outcomes, for a cohort of patients with moderate-to-severe ulcerative colitis from a Greek payer perspective. Patients entered the model in the active ulcerative colitis state and transitioned to a remission or response state or they underwent colectomy. Following an initial 8-week induction treatment period, patients received maintenance therapy until loss of response. Nonresponders could switch to up to two subsequent biologic lines. Clinical efficacy, adverse event rates and utilities derived from OCTAVE trials and a network-meta-analysis (NMA), while adverse event-related disutilities were obtained from the literature. Information on treatment pathways and resource use was provided by an advisory board due to a lack of local data. Unit costs derived from official national sources (€, 2018).
Over a life-time horizon, treating moderate-to-severe active ulcerative colitis with tofacitinib resulted in additional quality-adjusted life-years (QALYs) and lower total costs compared to vedolizumab (0.018; €6408), infliximab (biosimilar) (0.009; €3031), golimumab (0.042; €1988) and infliximab (originator) (0.009; €6724). Hence, tofacitinib was estimated to be dominant over all comparators.
The results of the analysis suggest that in the Greek setting, tofacitinib could be considered a cost-effective (dominant) treatment option for the treatment of patients with moderate-to-severe active ulcerative colitis.
评估托法替布相对于其他治疗方案在希腊中重度溃疡性结肠炎成人患者中的成本效益，这些患者对常规治疗或生物制剂反应不足、失去反应或不耐受。
从希腊支付者的角度出发，采用马尔可夫模型来预测中重度溃疡性结肠炎患者的终生成本和结果。患者进入模型时处于活跃的溃疡性结肠炎状态，并过渡到缓解或反应状态，或进行结肠切除术。在初始 8 周的诱导治疗期后，患者接受维持治疗直至失去反应。无反应者可转换至最多两种后续生物制剂线。临床疗效、不良反应发生率和效用来自 OCTAVE 试验和网络荟萃分析（NMA），而不良反应相关的失能则来自文献。由于缺乏当地数据，一个顾问委员会提供了治疗途径和资源使用的信息。单位成本来自官方国家来源（€，2018 年）。
在一生中，与 vedolizumab（0.018；€6408）、英夫利昔单抗（生物类似物）（0.009；€3031）、戈利木单抗（0.042；€1988）和英夫利昔单抗（原研药）（0.009；€6724）相比，用托法替布治疗中重度活动性溃疡性结肠炎可获得额外的质量调整生命年（QALY）和更低的总成本。因此，托法替布被估计优于所有对照药物。
分析结果表明，在希腊环境下，托法替布可能被视为治疗中重度活动性溃疡性结肠炎患者的一种具有成本效益的（主导）治疗选择。
