P0720 Cost-effectiveness of vedolizumab vs. ustekinumab as first-line biologic in treatment sequencing for ulcerative colitis in Canada
Notice bibliographique
Résumé
Abstract Background Vedolizumab and ustekinumab are biologic therapies indicated for adult patients with moderately to severely active ulcerative colitis (UC). Multiple factors can determine the choice of first-line biologic including response/remission rate, discontinuation rates, safety profile and treatment costs. An economic evaluation can be used to synthesize evidence to identify the optimal treatment sequences to maximize clinical and economic outcomes. The objective was to evaluate the cost-effectiveness of vedolizumab followed by ustekinumab vs. ustekinumab followed by vedolizumab for adult patients with UC who are anti-tumor necrosis factor (TNF)-naïve from a societal perspective in Canada. Methods A Markov model estimated the cost-effectiveness of two sequences for adult patients with UC who are anti-TNF-naïve: vedolizumab as first-line biologic followed by ustekinumab vs. first-line ustekinumab followed by vedolizumab. For both sequences, patients were assumed to receive adalimumab, infliximab, or tofacitinib as a third-line option with surgery available after failing the third-line treatment. Treatment effectiveness (response, remission, discontinuation, and safety profile) was informed by a de novo network meta-analysis.1 Since effectiveness data by treatment line were unavailable, treatment effectiveness was assumed to diminish by 10% for all subsequent therapy lines based on expert opinion.2,3 Treatment costs were informed by IQVIA DeltaPA List Prices, Ontario Drug Benefit Formulary, and recent Canada’s Drug Agency health technology assessments (HTAs). A clinical expert was consulted to ensure alignment with real-world practices. Utilities were informed by published literature and previous HTAs. A lifetime time horizon was taken, with costs and outcomes discounted at 1.5%. Probabilistic base-case analyses (n = 3,000) reported total costs (2024 Canadian dollars) and quality-adjusted life-years (QALYs). Scenario analyses explored the impact of different assumptions. Results The vedolizumab-first sequence resulted in an incremental gain of 0.013 QALYs (12.791 vs. 12.778) and saved $157 ($291,529 vs. $291,686). Patients remained on first-line biologic longer with the vedolizumab-first sequence due to a lower discontinuation rate. The vedolizumab-first sequence remains dominant if treatment effectiveness at later lines is assumed consistent with first-line, from a payer perspective and varying time horizons. Conclusion From this model, a vedolizumab-first treatment sequence was dominant resulting in incremental clinical benefit, and cost savings from a societal perspective, suggesting that this treatment strategy provides better value for anti-TNF-naïve patients with moderate-to-severe UC in Canada. References 1.Jiang J, Wojtowicz AM, Sanni O, Uyei J, Jin H, Lindsley K, et al. S1149 Comparative Efficacy and Safety of Subcutaneous Vedolizumab versus Other Targeted Inflammatory Bowel Disease Therapies in Patients With Moderate to Severe Ulcerative Colitis: A Network Meta-Analysis. Official journal of the American College of Gastroenterology | ACG. 2024 Oct;119(10S):S816. 2.Das R, Steinhart AH. Choosing Therapies in Ulcerative Colitis. Journal of the Canadian Association of Gastroenterology. 2023;7(1):9-21. 3.Lu X, Jarrett J, Sadler S, Tan M, Dennis J, Jairath V. Comparative efficacy of advanced treatments in biologic-naïve or biologic-experienced patients with ulcerative colitis: a systematic review and network meta-analysis. Int J Clin Pharm. 2023;45(2):330-341.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,005 | 0,023 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,002 | 0,005 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,001 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,008 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».