cost per response remission in biologics available in italy for the treatment of tnf α inhibitors naive patients with ulcerative colitis

Objective: This study compares the cost of a sustained response or remission (at 52 weeks' follow-up) across biologics approved in Italy for the treatment of moderately to severely active ulcerative colitis (UC), specifically among anti-TNF-α-naïve patients. The analysis is from the perspective of the national healthcare provider (SSN) for one year of treatment. Methods: Efficacy data about the induction of response/remission probabilities at 52 weeks and the number needed to treat (NNT) were derived from a network meta-analysis of randomized controlled clinical trials of the following drugs: infliximab (originator and biosimilar), adalimumab, golimumab and vedolizumab. It included the acquisition and administration costs of biologics, based on an activity-based costing analysis performed in 3 Italian centers of excellence for UC treatment. Results: The costs per patient in sustained response at 52 weeks were, in increasing order: vedolizumab €47,772 (95% CI €29,869 - €101,055), biosimilar infliximab €48,657 (95% CI €31,488 - €95,523), golimumab (100 mg every 4 weeks at maintenance) €57,940 (95% CI €38,00 - €106,206), golimumab (50 mg every 4 weeks at maintenance) €62,504 (95% CI €39,976 - €120,477), adalimumab €101,181 (95% CI €49,635 - €422,334). The costs per patient in sustained remission at 52 weeks were: vedolizumab €86,220 (95% CI €47,015 - €206,652), biosimilar infliximab €92,562 (95% CI €52,954 - €203,619). Conclusions: In patients with moderate to severe UC not previously treated with TNF-α inhibitors, treatment needed with vedolizumab to obtain a response or remission at 52 weeks of follow-up is less costly to the SSN compared with the other UC-approved biologics available in Italy

Modeling cost-effectiveness and health gains of a \ue2\u80\u9cuniversal\ue2\u80\u9d versus \ue2\u80\u9cprioritized\ue2\u80\u9d hepatitis C virus treatment policy in a real-life cohort

We evaluated the cost-effectiveness of two alternative direct-acting antiviral (DAA) treatment policies in a real-life cohort of hepatitis C virus\ue2\u80\u93infected patients: policy 1, \ue2\u80\u9cuniversal,\ue2\u80\u9d treat all patients, regardless of fibrosis stage; policy 2, treat only \ue2\u80\u9cprioritized\ue2\u80\u9d patients, delay treatment of the remaining patients until reaching stage F3. A liver disease progression Markov model, which used a lifetime horizon and health care system perspective, was applied to the PITER cohort (representative of Italian hepatitis C virus\ue2\u80\u93infected patients in care). Specifically, 8,125 patients naive to DAA treatment, without clinical, sociodemographic, or insurance restrictions, were used to evaluate the policies\ue2\u80\u99 cost-effectiveness. The patients\ue2\u80\u99 age and fibrosis stage, assumed DAA treatment cost of \ue2\u82\uac15,000/patient, and the Italian liver disease costs were used to evaluate quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER) of policy 1 versus policy 2. To generalize the results, a European scenario analysis was performed, resampling the study population, using the mean European country-specific health states costs and mean treatment cost of \ue2\u82\uac30,000. For the Italian base-case analysis, the cost-effective ICER obtained using policy 1 was \ue2\u82\uac8,775/QALY. ICERs remained cost-effective in 94%-97% of the 10,000 probabilistic simulations. For the European treatment scenario the ICER obtained using policy 1 was \ue2\u82\uac19,541.75/QALY. ICER was sensitive to variations in DAA costs, in the utility value of patients in fibrosis stages F0-F3 post\ue2\u80\u93sustained virological response, and in the transition probabilities from F0 to F3. The ICERs decrease with decreasing DAA prices, becoming cost-saving for the base price (\ue2\u82\uac15,000) discounts of at least 75% applied in patients with F0-F2 fibrosis. Conclusion: Extending hepatitis C virus treatment to patients in any fibrosis stage improves health outcomes and is cost-effective; cost-effectiveness significantly increases when lowering treatment prices in early fibrosis stages. (Hepatology 2017;66:1814\ue2\u80\u931825)

Modeling cost-effectiveness and health gains of a âuniversalâ versus âprioritizedâ hepatitis C virus treatment policy in a real-life cohort

We evaluated the cost-effectiveness of two alternative direct-acting antiviral (DAA) treatment policies in a real-life cohort of hepatitis C virusâinfected patients: policy 1, âuniversal,â treat all patients, regardless of fibrosis stage; policy 2, treat only âprioritizedâ patients, delay treatment of the remaining patients until reaching stage F3. A liver disease progression Markov model, which used a lifetime horizon and health care system perspective, was applied to the PITER cohort (representative of Italian hepatitis C virusâinfected patients in care). Specifically, 8,125 patients naive to DAA treatment, without clinical, sociodemographic, or insurance restrictions, were used to evaluate the policiesâ cost-effectiveness. The patientsâ age and fibrosis stage, assumed DAA treatment cost of â¬15,000/patient, and the Italian liver disease costs were used to evaluate quality-adjusted life-years (QALY) and incremental cost-effectiveness ratios (ICER) of policy 1 versus policy 2. To generalize the results, a European scenario analysis was performed, resampling the study population, using the mean European country-specific health states costs and mean treatment cost of â¬30,000. For the Italian base-case analysis, the cost-effective ICER obtained using policy 1 was â¬8,775/QALY. ICERs remained cost-effective in 94%-97% of the 10,000 probabilistic simulations. For the European treatment scenario the ICER obtained using policy 1 was â¬19,541.75/QALY. ICER was sensitive to variations in DAA costs, in the utility value of patients in fibrosis stages F0-F3 postâsustained virological response, and in the transition probabilities from F0 to F3. The ICERs decrease with decreasing DAA prices, becoming cost-saving for the base price (â¬15,000) discounts of at least 75% applied in patients with F0-F2 fibrosis. Conclusion: Extending hepatitis C virus treatment to patients in any fibrosis stage improves health outcomes and is cost-effective; cost-effectiveness significantly increases when lowering treatment prices in early fibrosis stages. (Hepatology 2017;66:1814â1825)