School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
Medical Affairs, Takeda (China) International Trading Company, Beijing, China.
Adv Ther. 2021 Aug;38(8):4233-4245. doi: 10.1007/s12325-021-01806-7. Epub 2021 Jun 5.
To compare the cost-effectiveness of vedolizumab with that of conventional therapy in patients with moderate-to-severe active Crohn's disease (CD) in China.
A decision tree and Markov model were built to predict the lifetime cost and health outcomes in the induction phase and maintenance phase of vedolizumab treatment and conventional therapy (a combination of corticosteroids, immunosuppressants, and aminosalicylates) in adult patients with moderate-to-severe active CD from the perspective of China's healthcare system. Clinical efficacy and health utility were derived from the GEMINI 2 and GEMINI 3 trials and published literature. Costs were mainly obtained from clinical physician surveys in China and are presented in 2020 US dollars. Health outcomes (quality-adjusted life years, QALYs) and costs were discounted at an annual rate of 5%. The incremental cost per QALY gained was used to compare the cost-effectiveness of the two treatments. One-way and probabilistic sensitivity analyses (PSAs) were performed to test the robustness of the model.
The model predicted more QALYs (9.92 vs 9.00 QALYs) and lower incurred costs ($288,284 vs $309,680) in vedolizumab than in conventional therapy in a mixed population (anti-TNF-naïve and anti-TNF-failure populations) over a lifetime horizon in the base-case analysis. Similar results were observed in the anti-TNF-naïve and anti-TNF-failure subgroups of patients with CD. One-way sensitivity analysis results suggested that health state cost was the most influential factor in the model. The PSA results supported the dominance of vedolizumab in the base-case analysis.
Vedolizumab appears to be a cost-effective strategy option in the treatment of adult patients with moderate-to-severe active CD in China in both anti-TNF-naïve and anti-TNF-failure populations.
比较维得利珠单抗与常规治疗在中重度活动期克罗恩病（CD）患者中的成本效益。
从中国医疗保健系统的角度出发，使用决策树和马尔可夫模型预测维得利珠单抗和常规治疗（皮质类固醇、免疫抑制剂和氨基水杨酸盐的组合）在中重度活动期 CD 成年患者诱导期和维持期的终生成本和健康结果。临床疗效和健康效用来自 GEMINI 2 和 GEMINI 3 试验和已发表的文献。成本主要来自中国临床医生的调查，并以 2020 年美元表示。健康结果（质量调整生命年，QALYs）和成本以每年 5%的速度贴现。增量成本每获得一个质量调整生命年用于比较两种治疗方法的成本效益。进行了单因素和概率敏感性分析（PSA）以测试模型的稳健性。
在基础分析中，模型预测维得利珠单抗在混合人群（抗 TNF 初治和抗 TNF 失败人群）的一生中可获得更多的 QALYs（9.92 比 9.00 QALYs）和更低的治疗成本（288284 美元比 309680 美元）。在 CD 患者的抗 TNF 初治和抗 TNF 失败亚组中也观察到了类似的结果。单因素敏感性分析结果表明，健康状态成本是模型中最具影响力的因素。PSA 结果支持在基础分析中维得利珠单抗的优势。
在中重度活动期 CD 成年患者的治疗中，维得利珠单抗在抗 TNF 初治和抗 TNF 失败人群中似乎是一种具有成本效益的治疗策略选择。
