Network meta-analysis and cost-effectiveness analysis of infliximab, cyclosporine and tacrolimus for ulcerative colitis

Background:Assess the efficiency and cost-effectiveness of infliximab, cyclosporine and tacrolimus for the treatment of ulcerative colitis (UC). Methods:A literature search identified studies that investigated infliximab, cyclosporine or tacrolimus compared with placebo in UC patients. Short-term, long-term remission rates and response rates were employed to assess efficacy. Odds ratios with 95% confidence intervals were analyzed. A Markov model was constructed to simulate the progression in a cohort of patients with UC, with an over 10 years of time horizon, with a discount rate of 3%, and established threshold of euro30,000/quality-adjusted life-year (QALY) or yen 82442/QALY. Results:Results of network meta-analysis showed that the order was cyclosporine, tacrolimus, infliximab and placebo from high rate to low with regard to short-term clinical response. The comparison between infliximab versus cyclosporine achieved an incremental cost effectiveness ratio (ICER) of euro184435/QALY and yen 531607/QALY, with a 0.34893 QALYs difference of efficacy, and an incremental cost of euro64355 and yen 185494. Tacrolimus versus cyclosporine reached an ICER of euro44236/QALY and yen 57494/QALY, with a difference of 0.40963 QALYs in efficacy, and a raising cost to euro18120 and yen 23551. The probabilistic sensitivity analysis shows that cyclosporine would be cost-effective in the 75.8% of the simulations, tacrolimus in the 24.2%, and infliximab for the 0%. Conclusion:Infliximab, cyclosporine and tacrolimus as salvage therapies are efficacious. For long-term of clinical remission, the order of pharmacological agents was tacrolimus, infliximab and cyclosporine from high efficacy to low while no significant difference is seen. In cost-effectiveness analysis, the cyclosporine versus infliximab or tacrolimus is expected to be at best.

Automated summary

Infliximab, cyclosporine, and tacrolimus are effective salvage therapies for ulcerative colitis. Tacrolimus has the highest efficacy in achieving long-term clinical remission, while cyclosporine is the most cost-effective option compared to infliximab or tacrolimus.