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Adalimumab for non-infectious uveitis: is it cost-effective?
  1. Inigo Bermejo1,
  2. Hazel Squires1,
  3. Edith N Poku1,
  4. Katy Cooper1,
  5. John W Stevens1,
  6. Jean Hamilton1,
  7. Ruth Wong1,
  8. Ian Pearce2,
  9. Fahd Mohammed Quhill3,
  10. Alastair K Denniston4
  1. 1 ScHARR, University of Sheffield, Sheffield, UK
  2. 2 St Paul’s Eye Unit, Royal Liverpool University Hospital, Liverpool, UK
  3. 3 Opthalmology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
  4. 4 Department of Opthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Inigo Bermejo, ScHARR, University of Sheffield, Sheffield S1 4DA, UK; inigo.bermejo{at}gmail.com

Abstract

Background/Aims Uveitis is inflammation inside the eye. Our objective was to assess the cost-effectiveness of adalimumab compared with current practice (immunosuppressants and systemic corticosteroids) in patients with non-infectious intermediate, posterior or panuveitis and to identify areas for future research.

Methods A Markov model was built to estimate costs and benefits of the interventions. Systematic reviews were performed to identify the available relevant clinical and cost-effectiveness evidence. Data collected in two key randomised controlled trials (VISUAL I and VISUAL II) were used to estimate the interventions’ effectiveness compared with the trials’ comparator arms (placebo plus limited current practice (LCP)). The analysis was performed from the National Health Service and Personal Social Services perspective. Costs were calculated based on standard UK sources.

Results The estimated incremental cost-effectiveness ratios (ICERs) of adalimumab versus LCP for the base case are £92 600 and £318 075 per quality-adjusted life year (QALY) gained for active and inactive uveitis, respectively. In sensitivity analyses, the ICER varied from £15 579 to £120 653 and £35 642 to £800 775 per QALY for active and inactive uveitis.

Conclusion The estimated ICERs of adalimumab versus LCP are above generally accepted thresholds for cost-effectiveness in the UK. Adalimumab may be more cost-effective in patients with active uveitis at greater risk of blindness. However, there is an unmet need for additional primary data to provide more reliable estimates in several important areas, including effectiveness of adalimumab versus current practice (instead of LCP), incidence of long-term blindness, adalimumab effectiveness in avoiding blindness, and rates and time to remission while on adalimumab.

  • drugs
  • inflammation
  • public health
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Footnotes

  • Contributors IB undertook the cost-effectiveness review and developed the cost-effectiveness model. HS coordinated the project and advised on the cost-effectiveness modelling. ENP and KC undertook the clinical effectiveness review. JWS and JH commented on statistical issues and feasibility of NMAs and RW performed the literature searches. AKD, IP and FMQ provided clinical advice. All authors were involved in drafting and commenting on the manuscript.

  • Funding The authors received financial support for this research from the National Institute of Health Research (NIHR) Health Technology Assessment (HTA) Program (project no. 15/64/07).

  • Disclaimer Any views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Department of Health.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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