A74 COST-EFFECTIVENESS OF VEDOLIZUMAB COMPARED TO INFLIXIMAB FOR THE MANAGEMENT OF MODERATE-TO-SEVERE ULCERATIVE COLITIS
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Bibliographic record
Abstract
Ulcerative colitis (UC) is a relapsing and remitting condition, characterized by inflammation and ulceration in the colon and rectum. Biologic therapies have shown to be effective in inducing and maintaining remission in patients with UC, however there is no general consensus regarding which biologics should be used as first-line therapy for patients with UC. In order to decide which biologics should be used, the cost of the drugs needs to be taken into consideration. Infliximab and vedolizumab are commonly used biologics for UC, however it is unknown which biologic is more cost-effective as first-line therapy for patients with moderate-to-severe disease. The aim of our study was to compare the cost-effectiveness of vedolizumab to infliximab for the management of moderate-to-severe ulcerative colitis. A Markov model was constructed to simulate the clinical disease course of UC patients after initiating either infliximab or vedolizumab. Drug costs were obtained from the Alberta Health Drug Benefit List, and the remaining costs were determined from the CIHI Patient Cost Estimator. Transition probabilities were attained from a review of the literature, and loss of response and complication rates for infliximab and vedolizumab were obtained from the ACT and GEMINI trials, respectively. Previously published utility values were used to assess patient’s quality of life in each disease state. Our main analysis used a time horizon of 5 years due to the lack of long-term data on these therapies. Time horizons of 10 and 15 years were assessed in our sensitivity analysis by extrapolation. Probabilistic sensitivity analysis was performed to characterize uncertainty related to all input parameters. Using a 5-year time horizon, vedolizumab costs $107,667 per patient and yields 2.23 quality-adjusted life years (QALYs). Infliximab costs $127,883 per patient and yields 2.30 QALYs. At a willingness-to-pay (WTP) threshold of $50,000 per QALY, probabilistic sensitivity analysis revealed that vedolizumab had a 69% probability of being cost-effective, and infliximab has a 31% probability of being cost-effective. Sensitivity analysis results for 10- and 15-year time horizons are displayed in Table 1. Infliximab and vedolizumab as first-line therapies have similar effectiveness, however vedolizumab’s lower cost results in it being considered more cost-effective compared to infliximab for the management of UC. Table 1. Cost and effectiveness of infliximab versus vedolizumab for ulcerative colitis patients using multiple time horizons The Centre of Excellence for Gastrointestinal Inflammation and Immunity Research
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it