Economic evaluation of two therapeutic sequences in the first-line treatment of moderate to severe active ulcerative rectocolitis in Italy

Authors

  • Patrizio Armeni Associate Professor of Practice of GHNP division, SDA Bocconi School of Management; Coordinator of Health Economics and HTA area – CERGAS, Director of Operations – LIFT Lab, Roma - Italy https://orcid.org/0000-0003-3150-3332
  • Elena Compagnucci UOC Farmacia, A.O. San Camillo-Forlanini, Roma - Italy https://orcid.org/0009-0001-8720-3323
  • Gionata Fiorino UOS MICI, Dipartimento di Gastroenterologia, Ospedale San Camillo-Forlanini, Roma; Dipartimento di Gastroenterologia ed Endoscopia Digestiva, Ospedale San Raffaele e Università Vita-Salute San Raffaele, Milano - Italy https://orcid.org/0000-0001-5623-2968
  • Vincenzo Lolli Direttore U.O.C. Farmacia Ospedali Riuniti Padova Sud, Azienda ULSS 6 Euganea, Padova - Italy
  • Grazia Mazzone Azienda Sanitaria Locale Bari (ASL BA), Area Gestione Farmaceutica Territoriale, Bari - Italy https://orcid.org/0009-0004-4344-2391
  • Ambrogio Orlando Inflammatory Bowel Disease Unit, Department of Medicine, “Villa Sofia-Cervello” Hospital, Palermo - Italy
  • Mariabeatrice Principi UOC di Gastroenterologia, Dipartimento di Precisione e Medicina rigenerativa e Area Ionica (DiMePRe-J), Azienda Policlinico-Universitaria, Bari - Italy
  • Roberto Ravasio HEOR & RWE, PharmaLex Italy, Milano - Italy https://orcid.org/0000-0002-5477-1957
  • Fernando Rizzello IBD Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna; Department of Medical and Surgical Sciences, University of Bologna, Bologna - Italy
  • Edoardo Vincenzo Savarino Department of Surgery, Oncology and Gastroenterology, University of Padua - Italy https://orcid.org/0000-0002-3187-2894
  • Francesca Tombari U.O. Farmacia Clinica, Produzione e Ricerca, Dipartimento Farmaceutico Interaziendale, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna - Italy

DOI:

https://doi.org/10.33393/ao.2024.2893

Keywords:

Cost-Consequence Analysis, Inflammatory Bowel Disease, Infliximab, Ulcerative Colitis, Ulcerative Rectocolitis, Vedolizumab

Abstract

Background: Vedolizumab (VDZ) and infliximab are used to treat moderate to severe ulcerative colitis (UC). The choice of the drug to use at first-line is often based on a combination of clinical and economic factors. The cost of treatment pathway is rarely considered. Therefore, this cost-consequence analysis (CCA) investigated the overall costs of treatment pathway for vedolizumab followed by infliximab (VDZ → IFX) compared to infliximab followed by vedolizumab (IFX → VDZ).

Methods: We used a published cost-consequence model (CCM), based on a targeted literature search reporting the time-on-treatment data for vedolizumab or infliximab in UC in first and second-line of treatment. CCM time horizon was defined by the length of treatment sequences. Considering the Italian hospital perspective, the CCA evaluated the biologic drugs acquisition costs, drug administration costs, hospitalization costs, switch costs, colectomy costs and third-line treatment costs. Third-line options included colectomy, tofacitinib, ustekinumab or dose escalation of second-line biologic.

Results: Over the 5.2-year time horizon (duration of the longer VDZ → IFX pathway), the mean cost per patient of VDZ → IFX pathway was slightly lower than the mean cost per patient of IFX → VDZ pathway (€ 86,339 vs 89,636). The CCM predicted that using VDZ as first-line treatment delayed the time to costly third-line therapies compared to first-line using IFX (VDZ-first-line median time-on-treatment 3.6-years and IFX-second-line 1.6-years; IFX-first-line 1.4-years and VDZ-second-line 2.3-years and third-line 1.5-years).

Conclusion: The CCA showed that a biologic treatment pathway that begins with first-line vedolizumab is not more expensive than one beginning with first-line infliximab and delayed the time to costly third-line.

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References

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Published

2024-03-02

How to Cite

Armeni, P., Compagnucci , E., Fiorino, G., Lolli, V., Mazzone , G., Orlando, A., Principi, M., Ravasio, R., Rizzello, F., Savarino, E. V., & Tombari, F. (2024). Economic evaluation of two therapeutic sequences in the first-line treatment of moderate to severe active ulcerative rectocolitis in Italy. AboutOpen, 11(1), 21–29. https://doi.org/10.33393/ao.2024.2893

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Original research articles

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Received 2023-12-18
Accepted 2024-02-08
Published 2024-03-02

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