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Comparative Study
. 2017 Apr;35(4):479-491.
doi: 10.1007/s40273-016-0480-2.

A Cost-Effectiveness Analysis of Nintedanib in Idiopathic Pulmonary Fibrosis in the UK

C Rinciog  1 , M Watkins  2 , S Chang  3 , T M Maher  4   5 , C LeReun  6 , D Esser  7 , A Diamantopoulos  3
Affiliations
Comparative Study

A Cost-Effectiveness Analysis of Nintedanib in Idiopathic Pulmonary Fibrosis in the UK

C Rinciog et al. Pharmacoeconomics. 2017 Apr.

Abstract

Background: International guidelines recommend nintedanib (OFEV®) as an option for the treatment of idiopathic pulmonary fibrosis (IPF).

Objective: The objective of this study was to assess the cost effectiveness of nintedanib versus pirfenidone, N-acetylcysteine and best supportive care (BSC) for the treatment of IPF from a UK payer's perspective.

Methods: A Markov model was designed to capture the changes in the condition of adults with IPF. Efficacy outcomes included mortality, lung function decline and acute exacerbations. Treatment safety (serious adverse events) and tolerability (overall discontinuation) were also considered. The baseline risk of these events was derived from patient-level data from the placebo arms of nintedanib clinical trials (TOMORROW, INPULSIS-1, INPULSIS-2). A network meta-analysis (NMA) was conducted to estimate the relative effectiveness of the comparator treatments. Quality of life and healthcare resource use data from the clinical trials were also incorporated in the economic model.

Results: Nintedanib showed statistically significant differences against placebo on acute exacerbation events avoided and lung function decline. In the cost-effectiveness analysis, the results were split between two treatments with relative low costs and modest effectiveness (BSC and N-acetylcysteine) and two that showed improved effectiveness (lung function) and higher costs (nintedanib and pirfenidone). All comparators were assumed to have similar projected survival and the difference in quality-adjusted life-years (QALYs) was driven by the acute exacerbations and lung function estimates. In the base-case deterministic pairwise comparison with pirfenidone, nintedanib was found to have fewer acute exacerbations and resulted in less costs and more QALYs gained.

Conclusions: Compared with BSC (placebo), nintedanib and pirfenidone were the only treatments to show statistical significance in the efficacy parameters. We found substantial uncertainty in the overall cost-effectiveness results between nintedanib and pirfenidone. N-Acetylcysteine was largely similar to BSC but with a worse survival profile. INPULSIS-1 and INPULSIS-2 ClinicalTrials.gov numbers, NCT01335464 and NCT01335477.

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Conflict of interest statement

Funding

This study was funded by Boehringer Ingelheim. Boehringer Ingelheim was involved in the analysis of clinical trial data.

Conflicts of interest

CR, SC and AD are employed by Symmetron Ltd, which received funding from Boehringer Ingelheim for this project. CLR received funding for this project from Symmetron Ltd. TMM has received consulting fees from Symmetron Ltd; industry-academic research funding from GlaxoSmithKline R&D, UCB and Novartis; and consultancy or speakers fees from AstraZeneca, Bayer, Biogen Idec, Boehringer Ingelheim, Cipla, Dosa, Galapagos, GlaxoSmithKline R&D, ProMetic, Roche (and previously InterMune), Sanofi-Aventis, Takeda and UCB. TMM is supported by a National Institute for Health Research (NIHR) Clinician Scientist Fellowship (NIHR ref: CS-2013-13-017). DE is an employee of Boehringer Ingelheim. MW was an employee of Boehringer Ingelheim UK at the time this study was conducted. A copy of the cost-effectiveness model was provided to the journal for external review.

Figures

Fig. 1
Fig. 1
Model structure
Fig. 2
Fig. 2
Comparison of overall survival of the model best supportive care arm with observational data [5, 19]. BSC best supportive care
Fig. 3
Fig. 3
Tornado diagram for nintedanib vs. best supportive care
Fig. 4
Fig. 4
Cost-effectiveness scatter plot. BSC best supportive care, PSA probabilistic sensitivity analysis, QALYs quality-adjusted life-years
Fig. 5
Fig. 5
Multiple cost-effectiveness acceptability curve. BSC best supportive care
See this image and copyright information in PMC

References

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