Economic evaluations of biological treatments for moderate-to-severe Crohn's Disease

Abstract

P1788Introduction: Moderate-to-severe Crohn’s disease (CD) is a chronic, progressive disease characterized by inflammation of the lining of the gut.Treatment options include targeted biological therapies such as tumornecrosis factor (TNF)-alpha inhibitors (e.g. infliximab, adalimumab) andanti-integrin and anti-IL-23 treatments (vedolizumab, ustekinumab). Withincreasing treatment options, understanding economic evaluations ofdifferent therapies is crucial to inform clinical practice. The aim of thissystematic literature review (SLR) was to summarize published economicevaluation models of biologic treatments for CD in Europe.Aims & Methods: An SLR was conducted to identify studies (economicanalyses, systematic literature reviews, meta-analyses, and health technology assessments [HTAs]) of biological therapies in patients with moderate-to-severe CD, published in English from 1 January 2012 to 22 June 2018.Literature searches were performed in MEDLINE, Embase, EconLit, and theCochrane library databases. Conference abstracts from the past 2 yearswere reviewed, along with key HTA websites. Bibliographic lists of relevantSLRs were also interrogated. Study selection was guided by prespecifiedinclusion and exclusion criteria.Results: Thirteen economic analyses were identified, of which 10 compared biological treatment with biological and/or conventional therapy,1 compared biological treatment with surgery and 2 focused on clinicalmanagement of CD. Biologics considered included infliximab, infliximabbiosimilar, adalimumab, vedolizumab, and ustekinumab. Ten analyseswere performed from a health systems perspective while three studiespresented data from a societal perspective. Economic models utilized inthe studies included decision tree models, Markov models, or hybrid decision tree-Markov approaches. The models were built around key endpoints of response and remission. Efficacy of first- and second-generationbiologics when compared with one another was estimated primarily using network meta-analyses. The time horizon of analyses ranged from 48weeks to lifetime. Key health states considered include remission, milddisease, moderate/severe disease, surgery, and death. The value of second-generation biologics (vedolizumab and ustekinumab) was examinedseparately in anti-TNF naïve and anti-TNF failure patient populations infive studies. These biologics were more cost effective in the anti-TNF failure population than the anti-TNF naïve group. Sequencing of biologicswas considered in two analyses.Conclusion: Several modelling structures have been used to model CD using various time horizons. As treatment options for CD increase in Europe,economic evaluations comparing biologics to each other has become increasingly important. In addition, as more treatments are approved, theimpact of sequencing of biologics may need to be considered and may inturn dictate analyses of longer time horizons.Disclosure: Medical writing support was provided by Emily Colbeck, ofPharmaGenesis London, London, UK, and funded by Shire, a Takeda company. Molly Purser, Rikal Bhaila, Louise Hartley, and Stephanie Earnshaware employees of RTI Health Solutions, an independent research organization, which received research funding from Shire, a Takeda company,for this and other studies and from other pharmaceutical companies thatmarket drugs for the treatment of patients with Crohn’s disease and othermedical conditions. Arpita Nag is an employee of Shire, a Takeda company.