Assessing the economics of biologic and small molecule therapies for the treatment of moderate to severe ulcerative colitis in Japan: a cost per responder analysis of upadacitinib

Abstract

Aim

Patients with moderately to severely active ulcerative colitis have an increasing number of advanced therapy options including several biologics and Janus kinase inhibitors. Though data on efficacy and safety of these advanced therapies are available, less is known about the potential economic implications of their utilization in Japan. We evaluated the relative value of these advanced therapies in Japan using a locally developed cost per responder model.

Methods

A model was developed using relevant clinical endpoints and treatment costs to calculate cost per responder of all advanced therapies used for moderately to severely active ulcerative colitis treatment in Japan. Cost per responder was assessed in biologic-naïve and biologic-exposed populations, respectively. The model incorporated induction and maintenance therapy pathways as patients progressed through based on efficacy rates (clinical response, clinical remission and endoscopic improvement). Total costs for induction and maintenance included: drug acquisition, drug administration and serious adverse event management (as necessary) for responders, with additional rescue treatment cost only for non-responders.

Results

Upadacitinib showed lower cost per clinical response and cost per clinical remission across both biologic-naïve and biologic-exposed populations with only one exemption in cost per clinical remission in biologic-naïve population. In addition, upadacitinib demonstrated lower cost per endoscopic improvement in both populations. Janus kinase inhibitors outperformed with lower cost per responder than other mediations across all outcomes and patient populations with the exception of tofacitinib for clinical remission in biologic-exposed UC population.

Limitations

Comparative data used in this analysis have been derived from network meta-analysis, not from direct comparison.

Conclusions

The results of this cost per responder analysis suggest upadacitinib is a cost-effective option for the first- and second-line treatment of moderately to severely active ulcerative colitis in Japan.

Keywords:

• Cost per responder
• clinical remission
• biologics
• Janus kinase inhibitors
• ulcerative colitis

JEL CLASSIFICATION CODES:

• I15
• I1
• I
• C01
• C

Transparency

 

Declaration of financial/other interests

MS has received grants or contracts from Mochida Pharmaceutical Co., Ltd, Zeria Pharma Co., Ltd, EA Pharma Co., Ltd, Kissei Pharmaceutical Co., Ltd and EPS Corporation; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AbbVie GK, Janssen Pharmaceutical K.K., Mitsubishi Tanabe Pharma Co., Ltd, Takeda Pharmaceutical Co., Ltd, EA Pharma Co., Ltd, Gilead Sciences K.K. and Kissei Pharmaceutical Co., Ltd. IK and YO are employees of AbbVie GK and may hold AbbVie stocks/stock options. YSG is an employee of AbbVie Inc. and may hold AbbVie stock/stock options. NN was an employee of AbbVie GK at the time of conducting this study. XT and RM are employees of Syneos Health.

Author contributions

All authors contributed to the design of the study, model development, parameterization, and analysis or interpretation of the data. All authors had access to relevant data and participated in the drafting, review, and approval of this publication. No honoraria or payments were made for authorship.

Acknowledgements

We express our sincere gratitude to Alexis Masclet of Syneos Health for medical writing support for this article. In addition, the authors would like to thank Real World Evidence and HEOR Consulting teams at Syneos Health for technical support for this article.

Data availability statement

The data supporting the findings of this study are available within the article and its online supplementary materials.

Reviewer disclosures

Peer reviewers on this manuscript have received an honorarium from JME for their review work but have no other relevant financial relationships to disclose.

Additional information

Funding

This work was supported solely by AbbVie, which paid service fees to Syneos Health and funded this study, participated in the study design, research, analysis, data collection, interpretation of data, reviewing, and approval of the publication.