Gil Fabio, Juliao-Baños Fabian, Amador Luisa, Castano Natalia, Reyes Juan Manuel
Clinica Colombia, Bogotá, Colombia.
Hospital Pablo Tobon Uribe, Medellin, Colombia.
Pharmacoecon Open. 2022 Nov;6(6):837-846. doi: 10.1007/s41669-022-00360-4. Epub 2022 Aug 9.
The aim of this study was to evaluate the cost effectiveness of tofacitinib versus other treatment options currently available in Colombia in naïve to biologics (first-line) and exposed to biologics (second-line) patients with moderate to severe active ulcerative colitis (UC).
A Markov model was constructed with 8-week cycles, simulating a cohort of patients in a 5-year time horizon. The health states included remission, treatment response, active UC, and colectomy. The transition probabilities for the induction and maintenance phase were obtained from a network meta-analysis, and effectiveness was measured using quality-adjusted life-years (QALYs). Unit costs were derived from official national sources.
For first line, the incremental cost-effectiveness ratio (ICER) per QALY was $883 for tofacitinib and $3619 for infliximab, compared with adalimumab. Sensitivity analysis showed that tofacitinib is cost effective in 45% of the iterations, adalimumab in 5%, and infliximab in 50%. Meanwhile, the ICER of adalimumab was $14,927 compared with tofacitinib in second-line treatment. In the sensitivity analysis, tofacitinib was cost effective in 64% of the iterations, followed by adalimumab in 36%. Infliximab and golimumab were not included due to data limitations in the network meta-analysis of second-line treatment.
The analysis suggests that in Colombia, treatment with tofacitinib for patients with moderate-to-severe UC is a cost-effective option in both lines compared with other treatment options.
本研究旨在评估托法替布与哥伦比亚目前可获得的其他治疗方案相比，在初治生物制剂（一线）和曾接受生物制剂治疗（二线）的中重度活动性溃疡性结肠炎（UC）患者中的成本效益。
构建一个马尔可夫模型，周期为8周，模拟一组患者5年的病程。健康状态包括缓解、治疗反应、活动性UC和结肠切除术。诱导期和维持期的转移概率来自网络荟萃分析，有效性用质量调整生命年（QALYs）衡量。单位成本来自国家官方来源。
在一线治疗中，与阿达木单抗相比，托法替布每QALY的增量成本效益比（ICER）为883美元，英夫利昔单抗为3619美元。敏感性分析表明，在45%的迭代中托法替布具有成本效益，5%为阿达木单抗，50%为英夫利昔单抗。同时，在二线治疗中，阿达木单抗与托法替布相比的ICER为14927美元。在敏感性分析中，托法替布在64%的迭代中具有成本效益，其次是阿达木单抗，占36%。由于二线治疗网络荟萃分析中的数据限制，未纳入英夫利昔单抗和戈利木单抗。
分析表明，在哥伦比亚，与其他治疗方案相比，托法替布治疗中重度UC患者在一线和二线治疗中都是具有成本效益的选择。
