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Cost-Effectiveness Analysis of Adalimumab Versus Cyclosporine for Vogt-Koyanagi-Harada Disease: A Randomized
Lingyu Dai1, Zhenyu Zhong1, Qiuying Wu1
1The First Affiliated Hospital of Chongqing Medical University, Chongqing Branch (Municipality Division) of National Clinical Research Center for Ocular Diseases, Chongqing, People's Republic of China.
Insights
For Vogt-Koyanagi-Harada (VKH) disease, cyclosporine-corticosteroids (CSA-CS) is likely more cost-effective than adalimumab-corticosteroids (ADA-CS). CSA-CS is recommended as the preferred initial treatment choice for most VKH patients.
Area of Science:
- Ophthalmology
- Health Economics
- Pharmacoeconomics
Background:
- Vogt-Koyanagi-Harada (VKH) disease is a multisystem inflammatory disorder.
- Treatment decisions for VKH often involve balancing efficacy with cost-effectiveness.
- Adalimumab-corticosteroids (ADA-CS) and cyclosporine-corticosteroids (CSA-CS) are treatment options.
Purpose of the Study:
- To compare the 26-week cost-effectiveness of ADA-CS versus CSA-CS for treating VKH.
- To determine the incremental cost-effectiveness ratio (ICER) for both treatment strategies.
Main Methods:
- A cost-effectiveness analysis was conducted using data from a randomized-controlled trial.
- Per-protocol population data were analyzed for costs and quality-adjusted life-years (QALYs).
- Subgroup and sensitivity analyses were performed for early and late-phase VKH.
Main Results:
- The ICER for ADA-CS compared to CSA-CS was $62,425/QALY at 26 weeks.
- ADA-CS was associated with higher costs (ΔA-C: $2,497) but greater QALY gains (ΔA-C: 0.04).
- The probability of ADA-CS being cost-effective was low at common willingness-to-pay thresholds.
Conclusions:
- The CSA-CS strategy is likely the preferred initial treatment choice for most patients with VKH.
- This recommendation holds true regardless of whether the VKH is in its early or late phase.
Purpose:
To compare the 26-week cost-effectiveness of adalimumab-corticosteroids (ADA-CS) and cyclosporine-corticosteroids (CSA-CS) for Vogt-Koyanagi-Harada (VKH).
Methods:
A preplanned cost-effectiveness analysis based on the per-protocol population of a randomized-controlled trial. VKH subjects were randomized to receive either cyclosporine (100-200 mg daily) combined with corticosteroids or adalimumab (40 mg twice monthly) combined with corticosteroids. The primary outcome of this cost-effectiveness study was the incremental cost-effectiveness ratio (ICER). Costs and quality-adjusted life-years (QALYs) data were calculated by the medical records and health utility, respectively. Subgroup (early and late-phase VKH) analysis and sensitivity analyses were performed.
Results:
The ICER at 26 weeks was $62,425/QALY for the total participants. Compared to the CSA-CS group, costs in the ADA-CS group were more expensive (mean difference [ΔA-C]: $2,497) with more gains in QALYs (mean difference [ΔA-C]: 0.04). The probability of ADA-CS being cost-effective was 0.17 and 0.41 at willingness to pay (WTP) thresholds of $12,000/QALY and $36,000/QALY, respectively. Subgroup analysis and sensitivity analyses showed consistent findings with the primary analysis.
Conclusions:
Regardless of early or late-phase VKH, the CSA-CS strategy may be recommended as the preferred initial choice for the majority of VKH.
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