title: Cost-effectiveness of vedolizumab compared with infliximab, adalimumab, and golimumab in patients with ulcerative colitis in the United Kingdom.
abstract: OBJECTIVE
  To examine the clinical and economic impact of vedolizumab compared with infliximab, adalimumab, and golimumab in the treatment of moderately to severely active ulcerative colitis (UC) in the United Kingdom (UK).
  
  
  METHODS
  A decision analytic model in Microsoft Excel was used to compare vedolizumab with other biologic treatments (infliximab, adalimumab, and golimumab) for the treatment of biologic-naïve patients with UC in the UK. Efficacy data were obtained from a network meta-analysis using placebo as the common comparator. Other inputs (e.g., unit costs, adverse-event disutilities, probability of surgery, mortality) were obtained from published literature. Costs were presented in 2012/2013 British pounds. Outcomes included quality-adjusted life-years (QALYs). Costs and outcomes were discounted by 3.5% per year. Incremental cost-effectiveness ratios were presented for vedolizumab compared with other biologics. Univariate and multivariate probabilistic sensitivity analyses were conducted to assess model robustness to parameter uncertainty.
  
  
  RESULTS
  The model predicted that anti-tumour necrosis factor-naïve patients on vedolizumab would accrue more QALY than patients on other biologics. The incremental results suggest that vedolizumab is a cost-effective treatment compared with adalimumab (incremental cost-effectiveness ratio of £22,735/QALY) and dominant compared with infliximab and golimumab. Sensitivity analyses suggest that results are most sensitive to treatment response and transition probabilities. However, vedolizumab is cost-effective irrespective of variation in any of the input parameters.
  
  
  CONCLUSIONS
  Our model predicted that treatment with vedolizumab improves QALY, increases time in remission and response, and is a cost-effective treatment option compared with all other biologics for biologic-naïve patients with moderately to severely active UC.
authors.affiliation: RTI Health Solutions, 300 Park Offices Drive, Research Triangle Park, NC, 27709, USA. mwilson@rti.org.
authors.forename: Michele R
authors.initials: MR
authors.lastname: Wilson
authors.affiliation: Takeda Pharmaceuticals AG, Zurich, Switzerland.
authors.forename: Annika
authors.initials: A
authors.lastname: Bergman
authors.affiliation: Takeda Pharmaceuticals AG, Zurich, Switzerland.
authors.forename: Helene
authors.initials: H
authors.lastname: Chevrou-Severac
authors.affiliation: Takeda UK Ltd., Bucks, UK.
authors.forename: Ross
authors.initials: R
authors.lastname: Selby
authors.affiliation: Takeda Development Centre Europe Ltd., London, UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Smyth
authors.affiliation: PHMR Limited, London, UK.
authors.forename: Matthew C
authors.initials: MC
authors.lastname: Kerrigan
mesh_terms: D000068879:Adalimumab / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000911:Antibodies, Monoclonal / Q000191:economics* / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics / Q000627:therapeutic use; D003093:Colitis, Ulcerative / Q000188:drug therapy*; D003362:Cost-Benefit Analysis; D006801:Humans; D000069285:Infliximab / Q000191:economics / Q000627:therapeutic use; D008297:Male; D006113:United Kingdom
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; C529000:golimumab; C543529:vedolizumab; D000069285:Infliximab; D000068879:Adalimumab
keywords: Cost-effectiveness; Economics; Inflammatory bowel disease; Ulcerative colitis; Vedolizumab