Health economic evaluation in idiopathic pulmonary fibrosis in France

Abstract

Background: Idiopathic pulmonary fibrosis (IPF) is a specific form of chronic, progressive, fibrosing interstitial pneumonia of unknown cause. To date, there is no specific cure for IPF, and only two treatments (pirfenidone and nintedanib) have marketing authorizations and recommendations in international and French guidelines.

Objectives: A cost-utility analysis (CUA) has been conducted to evaluate the efficiency of nintedanib, in comparison to all available alternatives, in a French setting using the official methodological guidelines.

Methods: A previously developed lifetime Markov model was adapted to the French setting by simulating the progression of IPF patients in terms of lung function decline, incidence of acute exacerbations, and death. Considering the effect of IPF on patients’ quality-of-life, a CUA integrating quality adjusted life years (QALY) was chosen as the primary outcome measure in the main analysis. One-way, probabilistic, and scenario sensitivity analyses were performed to evaluate the robustness of the model.

Results: Treatment with nintedanib resulted in an estimated total cost of €76,414 (vs €82,665 for pirfenidone). In comparison with all other available options, nintedanib was predicted to provide the most QALY gained (3.34 vs 3.29). This analysis suggests that nintedanib has a 59.0% chance of being more effective than pirfenidone and s 77.3% chance of being cheaper than pirfenidone. Sensitivity analyses showed the results of the CUA to be robust.

Conclusions: In conclusion, this CUA has found that nintedanib appears to be a more cost-effective therapeutic option than pirfenidone in a French setting, due to fewer acute exacerbations and a better tolerability profile.

Keywords:

• Idiopathic pulmonary fibrosis
• cost-benefit analysis
• nintedanib
• pirfenidone
• France

Transparency

Declaration of funding

This manuscript was funded by Boehringer Ingelheim.

Declaration of financial/other relationships

BIF declares sponsorship from Boehringer Ingelheim France. LC, VC, SB, and FP declare consultancy/advisory roles for Boehringer Ingelheim. VC also declares grant/research funding from Boehringer Ingelheim and Roche, and also a consultancy/advisory role for Actelion, Bayer, Boehringer Ingelheim, Biogen, Gilead, GSK, MSD, Novartis, Roche, Sanofi, Celgene, Promedior, and Galapagos NV. CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

Editorial support was provided by Jenny Lloyd, MedLink Healthcare Communications Limited and was funded by an unrestricted grant from Boehringer Ingelheim France.