Nintedanib cost-effectiveness in idiopathic pulmonary fibrosis in the UK

Objectives: To assess the cost-effectiveness of nintedanib versus pirfenidone, N-acetylcysteine and best supportive care (BSC) for the treatment of idiopathic pulmonary fibrosis from a UK payer's perspective. Methods: A cohort analysis was conducted using a Markov model. The analysis time-horizon was patient lifetime. The perspective was that of the UK National Health Service and Personal Social Services. A network meta-analysis was conducted to estimate the relative effectiveness of the comparator treatments. Efficacy outcomes included mortality, loss of lung function, and acute exacerbations. Toxicity (serious adverse events) and tolerability (overall discontinuation) were also considered. The baseline risk of each event was estimated using patient level data from the control arm of three randomised clinical trials (TOMORROW, INPULSIS-1, INPULSIS-2). Parametric modelling extrapolation was used for patient survival and time to acute exacerbations. EQ-5D collected from the clinical trials was analysed to fit the model health states. Similarly, healthcare resource use throughout all disease stages was incorporated in the model. The cost inputs were synthesised using unit cost information from UK sources. Discounting of the model outcomes was applied in line with the NICE reference case. Results: Given the high incremental cost difference (approximately £60,000) between the new pharmacological treatments, nintedanib and pirfenidone, versus BSC alone, the incremental cost-effectiveness ratios (ICERs) were over £100,000 per quality-adjusted life-year (QALY) gained. In a pairwise comparison against pirfenidone, nintedanib dominated (less expensive and more effective). The results were driven by fewer acute exacerbations. N-acetylcysteine was dominated by BSC (more expensive and less effective). The model results were robust in a range of one-way deterministic, probabilistic, and structural sensitivity analyses. Conclusions: The ICER for nintedanib versus BSC was over £100,000 per QALY gained. N-acetylcysteine was inferior to BSC. Nintedanib was less costly and generated more QALYs than pirfenidone, due to fewer acute exacerbations.