Cost-Effectiveness of Nintedanib for Patients with Progressive Fibrosing Interstitial Lung Disease (PF-ILD)

Lotte Westerink; Jelmer Lennart Jens Nicolai; Maarten Jacobus Postma; Job Frank Martien van Boven; Cornelis Boersma

doi:10.1007/s41669-022-00354-2

Cost-Effectiveness of Nintedanib for Patients with Progressive Fibrosing Interstitial Lung Disease (PF-ILD)

Pharmacoecon Open. 2022 Sep;6(5):647-656. doi: 10.1007/s41669-022-00354-2. Epub 2022 Aug 4.

Authors

Lotte Westerink^{1

2}, Jelmer Lennart Jens Nicolai³, Maarten Jacobus Postma^{4

5

6}, Job Frank Martien van Boven⁷, Cornelis Boersma^{4

8

9}

Affiliations

¹ Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. lotte.westerink@ascacademics.com.
² Asc Academics Inc., 12 East 49th Street, New York, NY, 10017, USA. lotte.westerink@ascacademics.com.
³ Boehringer Ingelheim International GmbH, Alkmaar, The Netherlands.
⁴ Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
⁵ Unit of Pharmacotherapy, Epidemiology and Economics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
⁶ Department of Economics, Econometrics and Finance, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands.
⁷ Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, Groningen, The Netherlands.
⁸ Health-Ecore B.V., Zeist, The Netherlands.
⁹ Center of Post-initial Education, Open University, Heerlen, The Netherlands.

Abstract

Objectives: Progressive fibrosing interstitial lung disease (PF-ILD) is characterised by increased pulmonary fibrosis, lung function decline, acute exacerbations, decreased quality of life and increased mortality. Nintedanib may slow down disease progression, but long-term outcomes are unknown. We aimed to assess the cost-effectiveness of nintedanib in comparison to placebo, both on top of usual care in patients with PF-ILD.

Methods: An individual PF-ILD patient simulation model was created, using data and extrapolations from the nintedanib and placebo arms of the INBUILD trial. Clinical outcomes (mortality, exacerbations, lung transplants), economic outcomes (direct and indirect costs) and the cost-effectiveness of nintedanib over a 10-year time horizon were forecasted using the Netherlands as a case example. Disease progression was driven by lung function decline, with forced vital capacity (FVC) health states ranging from < 40 to ≥ 110 FVC of % predicted. Sensitivity and scenario analyses were performed to assess the impact of parameter assumptions on the cost-effectiveness and to test model robustness.

Results: Over a 10-year follow-up, nintedanib gained an average of 1.31 discounted life years and an average of 0.87 discounted quality-adjusted life years (QALYs), resulting in an incremental cost-effectiveness ratio (ICER) of €60,690 per QALY. Sensitivity analyses showed cost variations had a minor impact on the ICER. Results were mainly driven by mortality probabilities and disease-related utilities. Scenario analyses indicated most sensitivity to the time horizon and lung transplantation costs.

Conclusion: Long-term treatment with nintedanib could result in considerable health gains for patients with PF-ILD and can be considered cost-effective under the common willingness-to-pay threshold.