Cost-Effectiveness Analysis of Etrasimod Compared With Biologic Therapies for the Treatment of Patients with Moderately-to-Severely Active Ulcerative Colitis in Spain

BACKGROUND: Etrasimod (2 mg orally, once daily) is a novel advanced therapy (AT) for patients aged 16 years and older, with moderately-to-severely active ulcerative colitis (UC). This cost-effectiveness analysis compared etrasimod with biologics for the treatment of moderately-to-severely active UC within the Spanish healthcare system. METHODS: A mixed model was used to estimate direct health-related costs (€, 2025) and outcomes (quality-adjusted life years [QALYs]) during the patient's lifetime (annual discount rate: 3%). The model simulated the course of UC, including induction and maintenance treatments, modeled by a decision tree and a Markov model. Model inputs were derived from scientific literature. All data were validated by a multidisciplinary panel of national experts. Etrasimod was compared against commonly used treatments in Spain in AT-naïve (vs adalimumab, golimumab, infliximab, intravenous vedolizumab [vedolizumab-IV], subcutaneous vedolizumab [vedolizumab-SC]) and AT-experienced patients (vs adalimumab, golimumab, infliximab, ustekinumab, vedolizumab-IV, vedolizumab-SC) by estimating incremental cost-effectiveness ratios. RESULTS: Etrasimod yielded 19.505 QALYs and €600,289 per AT-naïve patient lifetime, being associated with more QALYs and cost savings than adalimumab (+0.042; -€35,084), golimumab (+0.107; -€39,424), infliximab (+0.039; -€49,514), vedolizumab-IV (+0.170; -€16,153) and vedolizumab-SC (+0.166; -€55,850). In AT-experienced patients, etrasimod produced 18.407 QALYs and €589,423/patient lifetime. In this population, etrasimod was also associated with more QALYs and cost-savings versus adalimumab (+0.013; -€20,850), ustekinumab (+0.018; -€39,354), vedolizumab-IV (+0.166; -€572) and vedolizumab-SC (+0.171; -€26,890). Etrasimod was dominant versus all biologic therapies. Deterministic and probabilistic sensitivity analyses varying all model inputs confirmed the robustness of the results (etrasimod dominancy). CONCLUSIONS: In AT-naïve and AT-experienced patients, etrasimod is a dominant therapy (cost savings, greater effectiveness) compared with commonly used ATs.