For a study, it was determined that despite available treatments, persons with lupus nephritis develop renal failure and had a lower life expectancy. Belimumab and voclosporin were two novel disease-modifying medicines for the treatment of lupus nephritis that was recently authorized. To evaluate the cost-effectiveness of these medicines, a de novo economic model was built, which included the following health states: “full response,” “partial response,” and “active disease,” which was characterized by changes in eGFR and proteinuria, renal failure, and mortality. Short-term data and mean cohort characteristics were obtained from pivotal clinical trials of belimumab (Belimumab International Study in Lupus Nephritis) and voclosporin (Aurinia Urinary Protection Reduction Active–Lupus with Voclosporin trial and Aurinia Renal Response in Active Lupus With Voclosporin trial). Survival modeling utilizing published Kaplan–Meier data was used to assess the risk of death and renal failure. Each medicine was compared to the standard of treatment represented by the comparator arm in its individual pivotal trial(s) from the standpoint of the US healthcare industry, with a societal perspective also investigated.
The increased cost-effectiveness ratio for belimumab compared to its control arm was predicted to be around $95,000 per quality-adjusted life year in a health care perspective probabilistic analysis. When voclosporin was compared to its control arm, the equivalent incremental ratio was around $150,000 per quality-adjusted life-year. When compared to their respective standard treatment arms, belimumab and voclosporin were 69% and 49% more likely to be cost-effective at a threshold of $150,000 per quality-adjusted life-year, respectively. The cost-effectiveness was determined by assumptions about survival in response states, costs and utilities inactive illness, and utility costs in response states. The incremental ratio for belimumab was projected to be roughly $66,000 every quality-adjusted life year in the societal analysis, whereas the incremental ratio for voclosporin was assessed to be approximately $133,000 per quality-adjusted life-year.
Belimumab, but not voclosporin, reached willingness-to-pay criteria of $100,000 per quality-adjusted life year when compared to their respective standard treatment arms. Despite probable therapeutic advantages in the informative studies, there was significant ambiguity about voclosporin’s cost-effectiveness.
Reference:cjasn.asnjournals.org/content/early/2022/02/22/CJN.13030921
