P424 Economic evaluation of vedolizumab SC for the treatment of moderate-to-severe ulcerative colitis in Canada
A. FISCHER1, M. Oppe2, S. Stypa1, V. Lukyanov3, I. Petrakis4
1Takeda Canada Inc., Patient Value and Access, Toronto, Canada, 2Axentiva Solutions, Pharmacoeconomic, Sta. Cruz de Tenerife, Spain, 3IQVIA, Real-World Insights, Amsterdam, The Netherlands, 4Takeda Inc., Payer Value and Patient Access, Boston, USA
Background
Vedolizumab intravenous (IV), a gut selective humanised monoclonal antibody, is indicated for the management of moderately to severely active Ulcerative Colitis (UC) and has been shown in the only head-to-head clinical trial within UC to be superior to adalimumab (NCT02497469). Furthermore, the novel vedolizumab subcutaneous (SC) has recently been proven to be an effective treatment of UC (NCT02611830). The objective of this study is to estimate the comparative cost-effectiveness of vedolizumab IV with updated efficacy data, and vedolizumab SC for the first time. Both vedolizumab IV and SC have been compared with other publicly reimbursed biologics for the treatment of patients with moderate-to-severe UC from a Canadian public healthcare payer perspective.
Methods
A hybrid decision tree/Markov model was developed to simulate the clinical course of UC, translating the disease course into costs and quality-adjusted life-years (QALYs). Comparative efficacy of vedolizumab SC, vedolizumab IV, adalimumab, infliximab IV, and golimumab were sourced from a network meta-analysis. Drug and disease management costs (2019 $CAD) were sourced from Ontario public payer schedules of benefits. Utilities were sourced from the literature. Clinical and economic outcomes were projected over a lifetime and discounted at 1.5% annually.
Results
Within a mixed bio-naïve/experienced population, vedolizumab SC resulted in slightly more QALYs than vedolizumab IV and dominated adalimumab (Table 1); vedolizumab SC yielded an incremental cost-effectiveness ratio (ICER) of $CAD 6,727 per QALY and $CAD 52,673 per QALY relative to golimumab and to infliximab (for which the price of a biosimilar was used), respectively. Further scenario analysis within bio-naïve populations supported the robustness of the base-case results, demonstrating that vedolizumab SC or vedolizumab IV were either dominant or cost-effective across all scenarios.
| Treatment | Cost* | QALYs | ICER vs. comparator |
| Vedolizumab SC | $723,915 | 14.38 | Reference |
| Vedolizumab IV | $725,841 | 14.36 | Vedolizumab SC is dominant |
| Adalimumab SC | $731,157 | 14.13 | Vedolizumab SC is dominant |
| Golimumab SC | $722,283 | 14.14 | $6,727 |
| Infliximab IV | $717,429 | 14.26 | $52,673 |
Cost year: 2019 $CAD
Conclusion
Our analysis suggests that vedolizumab SC and vedolizumab IV are a cost-effective therapeutic alternative relative to other biologics for moderate-to-severe UC in Canada. Future research will expand the analysis across all biologic comparators as they are used in the real world.