Table 3.
Summary of economic evaluations in the treatment of UC.
| Study, year of publication | Study treatment | Comparators | CE ratio (Cost/QALY) (Currency year) |
CE ratio ($/QALY) (CAD 2016) |
|---|---|---|---|---|
| IFX | ||||
|
| ||||
| Archer et al., 2016 [40] | IFX | Surgery | Dominated | Dominated |
| IFX | ADA | Dominated | Dominated | |
|
| ||||
| Chaudhary and Fan, 2013 [41] | IFX | Cyclosporine | €24,277/QALY (EUR 2010) |
$34,241/QALY |
| IFX | Surgery | €14,639/QALY (EUR 2010) |
$20,647/QALY | |
|
| ||||
| Hyde et al., 2009 [42] | Strategy A (IFX responders who achieved and maintained remission and mild health states) | Std care | £33,866/QALY (GBP 2009)∗ |
$78,180/QALY |
| Strategy B (IFX responders who achieved and maintained remission) | Std care | £25,044/QALY (GBP 2009)∗ |
$57,814/QALY | |
|
| ||||
| Punekar and Hawkins, 2010 [43] | IFX | Cyclosporine | £19,545/QALY (GBP 2006) |
$50,571/QALY |
| IFX | Std care | £18,388/QALY (GBP 2006) |
$47,578/QALY | |
|
| ||||
| Stawowczyk et al., 2016 [44] | IFX + std care | Std care | $106,743/QALY (USD 2015) |
$135,934/QALY |
|
| ||||
| Thorlund et al., 2014 [45] | IFX | Std care |
$65,982/QALY (CAD 2013) |
$68,093/QALY |
| IFX | ADA | Dominant | Dominant | |
|
| ||||
| Toor et al., 2015 [46] | IFX | Std care |
$1,975/Remission (CAD 2015)∗ |
$2,038/Remission |
| IFX | Std care |
$1,311/Response (CAD 2015)∗ |
$1,352/Response | |
| IFX | GOL (100 mg) |
$14,659/Remission (CAD 2015)∗ |
$15,128/Remission | |
| IFX | GOL |
$4,753/Response (CAD 2015)∗ |
$4,905/Response | |
|
| ||||
| Tsai et al., 2008 [47] | IFX MTN (responder strategy) | Std care | £27,424/QALY (GBP 2007) |
$70,958/QALY |
| IFX MTN (remission strategy) | Std care | £19,696/QALY (GBP 2007) |
$50,962/QALY | |
|
| ||||
| Ung et al., 2014 [48] | IFX | Std care |
$79,000/QALY (USD 2013) |
$85,596/QALY |
|
| ||||
| Williams et al., 2016 [49] | IFX | Cyclosporin | Dominated | Dominated |
|
| ||||
| Yokomizo et al., 2016 [50] | IFX (5 mg/kg) | IFX (10 mg/kg) | $1,243,310/MH (USD 2014) |
$1,366,933/MH |
| IFX (5 mg/kg) | ADA | Dominated | Dominated | |
| IFX (5 mg/kg) | VED | Dominated | Dominated | |
|
| ||||
| ADA | ||||
|
| ||||
| Archer et al., 2016 [40] | ADA | Surgery | Dominated | Dominated |
| ADA | Std care | £50,278/QALY (GBP2015)∗ |
$83,804/QALY | |
|
| ||||
| Thorlund et al., 2014 [45] | ADA | Std care |
$68,722/QALY (CAD 2013) |
$70,921/QALY |
|
| ||||
| Toor et al., 2015 [46] | ADA | Std care |
$7,430/Remission (CAD 2015)∗ |
$7,667/Remission |
| ADA | Std care |
$2,361/Response (CAD 2015)∗ |
$2,436/Response | |
| ADA | GOL (100 mg) | Dominated | Dominated | |
| ADA | GOL (100 mg) | Dominated | Dominated | |
|
| ||||
| IFX and ADA | ||||
|
| ||||
| Xie et al., 2009 [51] | IFX (5 mg/kg) then ADA (5 mg/kg) | Std care |
$358,088/QALY (CAD 2008) |
$402,490/QALY |
| IFX (5 mg/kg) then ADA (10 mg/kg) | Std care |
$575,540/QALY (CAD 2008) |
$646,907/QALY | |
|
| ||||
|
Other biologics (GOL, NAT, VED) |
||||
|
| ||||
| Archer et al., 2016 [40] | GOL | Surgery | Dominated | Dominated |
|
| ||||
| Essat et al., 2016 [52] | VED | Std care | £33,297/QALY (GBP 2016)∗ |
$54,283/QALY |
| VED | Surgery | Dominant | Dominant | |
| VED (Anti-TNF naïve pt) | IFX (Anti-TNF naïve pt) | Dominant | Dominant | |
| VED (Anti-TNF naïve pt) | GOL (Anti-TNF naïve pt) | Dominant | Dominant | |
| VED (Anti-TNF naïve pt) | ADA (Anti-TNF naïve pt) | £6,634/QALY (GBP 2016)∗ |
$10,815/QALY | |
| VED (Anti-TNF naïve pt) | Std care (Anti-TNF naïve pt) | £4,862/QALY (GBP 2016)∗ |
$7,926/QALY | |
| VED (Anti-TNF naïve pt) | Surgery (Anti-TNF naïve pt) | Dominant | Dominant | |
| VED (Anti-TNF failure) | Std care (Anti-TNF failure) | £64,999/QALY (GBP 2016)∗ |
$105,966/QALY | |
| VED (Anti-TNF failure) | Surgery (Anti-TNF failure) | Dominant | Dominant | |
|
| ||||
| Thorlund et al., 2014 [45] | GOL (50 mg) | Std care |
$41,591/QALY (CAD 2013) |
$42,921/QALY |
| GOL (100 mg) | Std care |
$42,271/QALY (CAD 2013) |
$43,623/QALY | |
| GOL (50 mg) | IFX | Dominant | Dominant | |
| GOL (100 mg) | IFX | Dominant | Dominant | |
| GOL (50 mg) | ADA | Dominant | Dominant | |
| GOL (100 mg) | ADA | Dominant | Dominant | |
|
| ||||
| Toor et al., 2015 [46] | GOL (100 mg) | Std care |
$935/Remission (CAD 2015)∗ |
$964/Remission |
| GOL (100 mg) | Std care |
$701/Response (CAD 2015)∗ |
$723/Response | |
| GOL (50 mg) | Std care |
$1,048/Remission (CAD 2015)∗ |
$1,081/Remission | |
| GOL (50 mg) | GOL (100 mg) |
$207/Remission (CAD 2015)∗ |
$213/Remission | |
| GOL (50 mg) | Std care |
$770/Response (CAD 2015)∗ |
$794/Response | |
| GOL (50 mg) | GOL (100 mg) |
$224/Response (CAD 2015)∗ |
$231/Response | |
|
| ||||
| 5-ASA | ||||
|
| ||||
| Brereton et al., 2010 [53] | 5-ASA (Mezavant XL, MMX) | 5-ASA (Asacol) | £749/QALY (GBP 2010) |
$2,058/QALY |
|
| ||||
| Buckland and Bodger, 2008 [54] | 5-ASA (High dose, Asacol) | 5-ASA (Std dose, Asacol) | Dominant | Dominant |
|
| ||||
| Connolly et al., 2009 [55] | 5-ASA (Oral + topical) | 5-ASA (Oral) | Dominant | Dominant |
|
| ||||
| Connolly et al., 2009 [56] | 5-ASA (2 g once daily) | 5-ASA (1 g twice daily) | Dominant | Dominant |
|
| ||||
| Connolly et al., 2012 [57] | 5-ASA (Oral + topical) | 5-ASA (Oral) | Dominant | Dominant |
| 5-ASA (2 g once daily) | 5-ASA (1 g twice daily) | Dominant | Dominant | |
|
| ||||
| Connolly et al., 2014 [58] | 5-ASA (2 g once daily) | 5-ASA (1 g twice daily + enema) | Dominant | Dominant |
|
| ||||
| Mackowiak, 2006 [59] | Oral balsalazide capsules | Oral 5-ASA specific formulation | Dominant | Dominant |
|
| ||||
| Nishikawa et al., 2013 [60] | 5-ASA (once daily) | 5-ASA (twice daily) | $86,200/LYG (RD 2011) |
$55,649/LYG |
|
| ||||
| Prenzler et al., 2011 [61] | 5-ASA (Mezavant XL, MMX) | 5-ASA (Asacol) | Dominant | Dominant |
|
| ||||
| Saini et al., 2012 [62] | SYMPT (5-ASA treatment for symptomatic disease flares only) | INFLAM (5-ASA therapy for only patients with a stool sample positive for an inflammatory marker) | $575,894/QALY (USD 2009) |
$715,331/QALY |
| SYMPT (5-ASA treatment for symptomatic disease flares only) | CONT (continuous 5-ASA maintenance) | Dominant | Dominant | |
|
| ||||
| Yen et al., 2008 [63] | MTN 5-ASA (2.4 g/day escalated and maintained at 4.8 g/day after the first flare) | No MTN 5-ASA (5-ASA 4.8 g/day given for flares) | $224,000/QALY (USD 2004) |
$353,545/QALY |
|
| ||||
|
Immunosuppressants (AZA, 6MP, cyclosporine) |
||||
|
| ||||
| Priest et al., 2006 [39] | AZA | MTX | Dominant | Dominant |
| AZA | No immunosuppressant therapy | Dominant | Dominant | |
|
| ||||
| Punekar and Hawkins, 2010 [43] | Cyclosporine | Standard care | Dominant | Dominant |
| Cyclosporine | Surgery | £9,032/QALY (GBP 2006) |
$23,370/QALY | |
|
| ||||
| Surgery | ||||
|
| ||||
| Archer et al., 2015 [40] | Surgery (colectomy) | Std care | Dominant | Dominant |
|
| ||||
| Park et al., 2012 [64] | Surgery (early colectomy + IPAA) | Std care | $1,476,783/QALY (USD 2009) |
$1,834,347/QALY |
|
| ||||
| Swenson et al., 2005 [65] | Two-Stage IPAA | Three-Stage IPAA | Dominant | Dominant |
|
| ||||
| GMA | ||||
|
| ||||
| Panes et al., 2007 [66] | GMA | Std care | €23,898/Remission (EUR 2004) |
$45,864/Remission |
ADA: adalimumab; AZA: azathioprine; CAD: Canadian dollar; CE: cost-effectiveness; EUR: Euros; g: gram; GBP: Great British Pound; GMA: granulocyte-monocyte aphaeresis; GOL: golimumab; IFX: infliximab; IPAA: Ileal Pouch-Anal Anastomosis; kg: kilogram; mg: milligram; LYG: life year gained; MH: mucosal healing; MTN: maintenance; MTX: methotrexate; NAT: natalizumab; pt: patient; QALY: quality adjusted life years; RD: Real Dollar; Std: standard; US: United States; USD: United States Dollar; VED: vedolizumab; 5-ASA: 5-aminosalicylic acid; 6MP: 6-mercaptopurine. Studies in italic are Canadian studies. A study may appear in more than one table if different treatments were analyzed. ∗Publishing year.