Certolizumab Pegol Compared to Natalizumab in Patients with Moderate to Severe Crohn's Disease: Results of a Decision Analysis
Certolizumab Pegol Compared to Natalizumab in Patients with Moderate to Severe Crohn's Disease: Results of a Decision Analysis
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DOI：
10.1007/s10620-011-1896-3
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发表时间：
2012-02-01
影响因子：
3.1
通讯作者：
Korzenik, Joshua R.
中科院分区：
文献类型：
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作者：
Ananthakrishnan, Ashwin N.;Hur, Chin;Korzenik, Joshua R.
相当大比例的克罗恩病(CD)患者对针对肿瘤坏死因子α(TNF)的抗体失去反应。先前的肿瘤坏死因子拮抗剂失败与随后的肿瘤坏死因子拮抗剂治疗的反应率较低有关。在两种抗肿瘤坏死因子药物治疗失败的患者中，存在使用第三种抗肿瘤坏死因子治疗或α-4整合素抑制剂那他珠单抗(NAT)之间的选择。我们构建了一个决策分析模型来比较Certolizumab pegol(CZP)和NAT在中重度CD患者中的表现。之前发表的对三线抗肿瘤坏死因子治疗和NAT疗效的估计被用来为该模型提供信息。成本以2010美元表示。一年的时间框架用于分析。在基本情况估计中，NAT的使用仅比CZP略高[0.71比0.70质量调整寿命年(QALY)]，但成本较高，每获得一QALY的增量成本-效果比(ICER)为381,678美元。对于CZP 2个月应答率至少为24%的患者，NAT的ICER高于支付意愿(WTP)阈值。该模型对两种疗法的成本都很敏感；对于每剂低于2,300美元的所有CZP成本，NAT的ICER高于WTP阈值。用阿达利单抗替代CZP导致NAT使用的ICER估计和阈值相似。在中到重度CD患者中，使用两种肿瘤坏死因子拮抗剂失败，使用第三种肿瘤坏死因子拮抗剂治疗似乎是一种成本效益高的策略，而不会显著影响治疗效果。
A significant proportion of patients with Crohn's disease (CD) lose response to antibodies directed against tumor necrosis factor alpha (TNF). Prior TNF-antagonist failure is associated with lower rates of response to subsequent TNF-antagonist therapy. In patients failing two anti-TNF agents, a choice exists between using a third-anti-TNF therapy or natalizumab (NAT), an alpha-4 integrin inhibitor. A cost-effectiveness analysis comparing these competing strategies has not been performed.A decision analytic model was constructed to compare the performance of certolizumab pegol (CZP) versus NAT in patients with moderate to severe CD. Previously published estimates of efficacy of third-line anti-TNF therapy and NAT were used to inform the model. Costs were expressed in 2010 US dollars. A 1-year time frame was used for the analysis.In the base case estimate, use of NAT was only marginally more effective [0.71 vs. 0.70 quality adjusted life-years (QALYs)] than CZP but was expensive with an incremental cost-effectiveness ratio (ICER) of $381,678 per QALY gained. For CZP 2 months response rate of at least 24%, NAT had an ICER above the willingness-to-pay (WTP) threshold. The model was sensitive to the costs of both therapies; for all CZP costs below $2,300 per dose, NAT had higher ICER than the WTP threshold. Substituting adalimumab for CZP resulted in similar ICER estimates and thresholds for NAT use.In patients with moderate to severe CD failing two TNF-antagonists, using a third TNF-antagonist therapy appears to be a cost-effective strategy without significantly compromising treatment efficacy.