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Infliximab versus ciclosporin in steroid resistant acute severe ulcerative colitis: a model-based cost-utility analysis of data from CONSTRUCT pragmatic trial
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Hayley Hutchings ,
Alan Watkins ,
Shaji Sebastain,
John Williams
BMC Health Services Research, Volume: 23, Issue: 1
Swansea University Authors:
Samantha Groves, Laith Alrubaiy , Hayley Hutchings , Alan Watkins , John Williams
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© The Author(s) 2023. This article is licensed under a Creative Commons Attribution 4.0 International License.
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DOI (Published version): 10.1186/s12913-023-09233-w
Abstract
BackgroundThere is limited evidence in the literature on the long-term effectiveness and cost-effectiveness of treatments for Acute Severe Ulcerative Colitis (ASUC). The study aimed to perform decision analytic model-based long-term cost-utility analysis (CUA) of infliximab versus ciclosporin for st...
| Published in: | BMC Health Services Research |
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| ISSN: | 1472-6963 |
| Published: |
Springer Science and Business Media LLC
2023
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| Online Access: |
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa62906 |
| Abstract: |
BackgroundThere is limited evidence in the literature on the long-term effectiveness and cost-effectiveness of treatments for Acute Severe Ulcerative Colitis (ASUC). The study aimed to perform decision analytic model-based long-term cost-utility analysis (CUA) of infliximab versus ciclosporin for steroid-resistant ASUC investigated in CONSTRUCT pragmatic trial.MethodsA decision tree (DT) model was developed using two-year health effect, resource use and costs data from CONSTRUCT trial to estimate relative cost-effectiveness of two competing drugs from the United Kingdom (UK) National Health Services (NHS) perspective. Using short-term trial data, a Markov model (MM) was then developed and evaluated over further 18 years. Both DT and MM were combined to investigate cost-effectiveness of infliximab versus ciclosporin for ASUC patients over 20-year time horizon, with a rigorous multiple deterministic and probabilistic sensitivity analyses to address uncertainty in results.ResultsThe decision tree mirrored trial-based results. Beyond 2-year trial follow-up, Markov model predicted a decrease in colectomy rate, but it remained slightly higher for ciclosporin. NHS costs and quality adjusted life years (QALYs) over base-case 20 year time horizon were £26,793 and 9.816 for ciclosporin and £34,185 and 9.106 for infliximab, suggesting ciclosporin dominates infliximab. Ciclosporin had 95% probability of being cost-effective at a willingness-to-pay (WTP) threshold value up to £20,000.ConclusionUsing data from a pragmatic RCT, the cost-effectiveness models produced incremental net health benefit in favour of ciclosporin relative to infliximab. Results from long-term modelling indicated that ciclosporin remains dominant compared with infliximab for the treatment of NHS ASUC patients, however, these need to be interpreted cautiously. |
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| Keywords: |
Ulcerative colitis; Infliximab; Ciclosporin; Cost-effectiveness; Decision tree; Markov model |
| College: |
Faculty of Medicine, Health and Life Sciences |
| Funders: |
Open Access funding provided by the Qatar National Library. The CONSTRUCT trial was funded by the NIHR Health Technology Assessment programme (project no. 06/78/03). |
| Issue: |
1 |