ISPOR 18th Annual European Congress
Milan, Italy
November, 2015
GI Disorders
Cost Studies (CS)
Cost-Effectiveness Analysis (CE), Cost-Utility Analysis (CU)
Sly IE1, Worbes-Cerezo M2, Cranmer H1, Thompson G2, Almond C1
1BresMed, Sheffield, UK, 2Janssen-Cilag UK, High Wycombe, UK
OBJECTIVES: A published economic model of biological therapies for moderate to severe Crohn’s disease was used recently in the National Institute for Health and Care Excellence (NICE) technology appraisal for vedolizumab. The objective of this study was to identify key drivers of cost effectiveness in Crohn’s disease. METHODS: The published economic model was reconstructed using data from Bodger et al. (2009), supplemented by the vedolizumab NICE submission. Costs were updated to 2013/14, and efficacy data were taken from the submission as this used a recent network meta-analysis (NMA). The reconstructed model omitted aspects of the vedolizumab submission that were heavily criticised by the Evidence Review Group (ERG).   The deterministic incremental cost-effectiveness ratios (ICER) from the re-constructed model were compared with those reported for the published model. A one-way sensitivity analysis of vedolizumab versus standard care was performed using the same assumptions as the submission base case, and the outputs of both models were compared.  RESULTS: For the base case results, Bodger et al. reported ICERs versus standard care of £19,050 for infliximab and £7,190 for adalimumab. In contrast, the reconstructed model reported ICERs of £54,077 and £31,210. These are similar to the results from the vedolizumab submission model, indicating that the differences are principally due to the use of NMA data from the submission. The key drivers were broadly similar between the reconstructed model and the submission model. These included the rates of response and remission during the induction period. Adverse events were also important; however, only those for standard care were key drivers in the submission, while adverse event rates for both treatments were important in the reconstructed model. CONCLUSIONS: Rates of response, remission and adverse events are important drivers of cost effectiveness in Crohn’s disease.