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Adalimumab for non-infectious uveitis: is it cost-effective?
Inigo Bermejo1, Hazel Squires2, Edith N Poku2
1ScHARR, University of Sheffield, Sheffield, UK inigo.bermejo@gmail.com.
The British Journal of Ophthalmology
|February 8, 2019
Summary
Adalimumab is not cost-effective for uveitis compared to current treatments, exceeding UK thresholds. It may benefit active uveitis patients at high blindness risk, but more data is needed.
Area of Science:
- Ophthalmology
- Health Economics
- Pharmacoeconomics
Background:
- Uveitis, an intraocular inflammation, necessitates evaluating treatment cost-effectiveness.
- Current standard care involves immunosuppressants and systemic corticosteroids.
- Non-infectious intermediate, posterior, or panuveitis requires effective and economical management strategies.
Purpose of the Study:
- To assess the cost-effectiveness of adalimumab versus current practice for non-infectious uveitis.
- To identify research gaps for optimizing uveitis treatment strategies.
Main Methods:
- A Markov model was employed to estimate costs and benefits.
- Systematic reviews informed the evidence base for clinical and economic data.
- Randomized controlled trials (VISUAL I and II) provided effectiveness data against placebo plus limited current practice (LCP).
Main Results:
- Incremental cost-effectiveness ratios (ICERs) for adalimumab versus LCP exceeded UK benchmarks (£92,600-£318,075 per QALY).
- Sensitivity analyses showed wide-ranging ICERs (£15,579-£800,075 per QALY).
- Adalimumab's cost-effectiveness may be higher in active uveitis cases with elevated blindness risk.
Conclusions:
- Adalimumab's current cost-effectiveness for uveitis in the UK is limited.
- Further research is essential to clarify adalimumab's comparative effectiveness against current treatments.
- Data on long-term blindness incidence, adalimumab's role in prevention, and remission rates are crucial for reliable estimates.
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