ELGART Jorge Federico
congresos y reuniones científicas
Cost per Response/Remission analysis of biologic therapies availables in Argentina for the treatment of Bio-exposed patients with moderate-to-severe active Ulcerative Colitis.
Congreso; 18th Congress of ECCO; 2023
Background: Response and remission are among the most clinically relevant outcomes for patients treated for ulcerative colitis (UC). The aim of the study is comparing the cost of a sustained clinical response or remission (at 52 weeks’ follow-up) across biologics available in Argentina for the treatment of bio-exposed patients with moderate-to-severe UC. Methods: Using a model developed in Excel, which combine efficacy event rates (clinical response/remission) and treatment costs, we estimated the cost per response or remission of the following UC treatments: adalimumab (ADA), tofacitinib (TOFA), upadacitinib (UPA), ozanimod, ustekinumab and vedolizumab (VEDO). Event rates were obtained from a published network meta-analysis (NMA) of Phase 3 randomized controlled trials (RCTs) in moderately-to-severely active UC (bio-naïve or bio-exposed patients)for the following efficacy outcomes: Clinical response and Clinical remission per Full Mayo (FM) score. Costs of treatments were estimated based on approved regimens and doses of each drug aswell as drug prices obtained from a publicly available list of prices. The cost per event was calculated as treatment cost divided by efficacy rate. For sensitivity, costs per event were also calculated using the 95% credible intervals from the NMA efficacy results. Costs per response/remission are expressed in US-dollars (exchange rate: US$1=AR$152.25, Sept 2022).Results: Considering the Clinical Response at 52 weeks, the lowest cost per responder therapies were: UPA (induction x maintenance: 45mg QD x 15mg QD) $58.216 [95% CrI $42.854 - $98.094]; UPA (45mg QD x 30mg QD) $79.270 [$62.146 - $121.400]; TOFA (10mg BID x 5mg BID) $109.708 [$65.205-$ 232.217]; and TOFA (10mg BID x 10mg BID) $154.218 [$99.169 -$296.204]. Likewise considering sustained remission the lowest costs per responder therapies were: UPA (45mg QD x 15mg QD) $64.782 [$42.658 - $136.390]; UPA (45mg QD x 30mg QD) $92.874 [$64.488- $182.236]; VEDO (300mg x 300mg Q8W) $278.299 [$124.766 - $779.009]; and TOFA (10mg BID x 5mg BID) $305.534 [$126.845 - $904.439]. The cost per responder was consistently lower for upadacitinib compared to all biologic treatments available in Argentina across both clinical measures. Conclusion: Among therapies for the treatment of bio-exposed patients with moderate-to-severe UC evaluated, upadacitinib have shown the lowest median cost per clinical remission and response from an Argentinian healthcare payer perspective.