COST-EFFECTIVENESS OF TOFACITINIB FOR THE TREATMENT OF MODERATE TO SEVERE ACTIVE ULCERATIVE COLITIS IN COLOMBIA

To evaluate the cost-effectiveness of tofacitinib versus other treatment options currently available in Colombia for the management of adult patients with moderate-to-severe ulcerative colitis in naïve to biologics (first line) and exposed to biologics (second line).

A Markov model was constructed with 8 weeks cycles. It simulates a cohort of patients with moderate-to-severe ulcerative colitis from a payer perspective in a 5-year horizon. The health states include remission, treatment response (without remission), active UC, and colectomy. The transition probabilities for the induction and maintenance phase were obtained from a network meta-analysis. Effectiveness was measured from quality-adjusted life-year (QALY) and the utilities were obtained from the literature. Unit costs were derived from official national sources, and these were expressed in US dollars 2021 at the average exchange rate of $3 693 COP/US. Probabilistic and deterministic sensitivity analyses were conducted. The threshold was defined as one gross domestic product ($5 391) per capita.

For first line, the incremental cost-effectiveness ratio (ICER) per QALY was for tofacitinib $2 611 and for infliximab $7 652 compared to adalimumab. Sensitivity analysis showed that tofacitinib is shown as cost-effective in 52% of the iterations, followed by adalimumab 25% and infliximab 23% patients. Meanwhile, adalimumab was $27 527 compared to tofacitinib in second line. Tofacitinib was cost-effective 72% of the iterations, followed by adalimumab 28% in the sensitivity analysis. Infliximab and golimumab were not included due to data limitation in network metanalysis in second line. For both lines vedolizumab was not a cost-effective alternative under the threshold assessed.

The analysis suggests that, in Colombia, the treatment with tofacitinib for moderate-to-severe UC patients is a cost-effective option in both lines, compare with other treatment options available.