ABSTRACT
OBJECTIVES: Assess the efficiency of biologic treatment for moderate to severe ulcerative colitis (UC) which are indicated and financed for this pathology by Spain. METHODS: A Markov model was constructed to simulate the progression in a cohort of patients with moderate to severe UC. The perspective chosen was National Health Service with an over 10 years of time horizon, with a discount rate of 3%, and established threshold of 30,000/quality-adjusted life-year (QALY). RESULTS: The comparison between infliximab versus adalimumab achieved an incremental cost-effectiveness ratio (ICER) of 45,582/QALY, with a 0.900 QALYs difference of efficacy and an incremental cost of 41,036. Golimumab versus adalimumab reached an ICER of 2,175,992/QALY, with a difference of 0.001 QALY in efficacy and a raising cost to 2,611. The comparison between vedolizumab with adalimumab achieved an ICER of 90,532/QALY, 0.930 QALYs of difference and an increasing cost of 84,218. The probabilistic sensitivity analysis shows that adalimumab would be cost-effective in the 65.2% of the simulations, infliximab in the 18.4%, golimumab in the 16.4% and vedulizumab for the 0%. CONCLUSIONS: Among all these drugs studied, adalimumab is the most cost-effective drug for the treatment of moderate to severe UC for a threshold of 30,000/QALY in Spain.
Subject(s)
Anti-Inflammatory Agents/therapeutic use , Colitis, Ulcerative/drug therapy , Gastrointestinal Agents/therapeutic use , Adalimumab/economics , Adalimumab/therapeutic use , Anti-Inflammatory Agents/economics , Antibodies, Monoclonal/economics , Antibodies, Monoclonal/therapeutic use , Antibodies, Monoclonal, Humanized/economics , Antibodies, Monoclonal, Humanized/therapeutic use , Colitis, Ulcerative/economics , Colitis, Ulcerative/physiopathology , Cost-Benefit Analysis , Gastrointestinal Agents/economics , Humans , Infliximab/economics , Infliximab/therapeutic use , Markov Chains , Quality-Adjusted Life Years , Severity of Illness Index , SpainSubject(s)
Charcoal/adverse effects , Gastric Lavage/adverse effects , Pneumonia, Aspiration/chemically induced , Respiratory Insufficiency/etiology , Adult , Bronchoscopy , Charcoal/administration & dosage , Female , Humans , Pneumonia, Aspiration/diagnosis , Pneumonia, Aspiration/therapy , Respiration, Artificial , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/therapy , Treatment OutcomeABSTRACT
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