OBJECTIVES: To evaluate the cost-effectiveness of upadacitinib in patients with moderately to severely active ulcerative colitis (UC), who have had an inadequate response, lost response or were intolerant to either conventional therapy (bio-naive) or a biologic agent (bio-exposed), in Greece.

METHODS: A cost-effectiveness model, consisted of an 8-week decision tree model (induction period) and a long-term Markov state-transition model with a 4-week cycle length (maintenance period), was locally adapted from a public payer perspective over a patient’s lifetime. Upadacitinib was compared to other UC marketed biologics and small molecule agents in Greece. Response to treatment in the induction and maintenance phase was obtained from a network meta-analysis. Non-responders moved to conventional care in the active UC Markov health state. Probabilities for surgical events and utility values were retrieved from published literature. Direct costs pertaining to drug acquisition, administration, disease management, and adverse events were considered in the analysis. All cost inputs were indexed to 2023 euros. The incremental cost effectiveness ratio (ICER) per a quality-adjusted life-year (QALY) gained was used as assessment tool. Sensitivity and scenario analyses were conducted.

RESULTS: In the bio-naïve population, compared to adalimumab, golimumab, infliximab, ozanimod, tofacitinib, ustekinumab, and vedolizumab, upadacitinib was found to be more effective (QALY gains: 0.833, 0.670, 0.671, 0.783, 0.314, 0.577, and 0.522, respectively) and cost-effective (ICERs: €18,618, €21,682, €17,864, €15,637, €30,061, €12,776, and €16,263, respectively). In the bio-exposed population, compared to adalimumab, ozanimod, tofacitinib, ustekinumab, and vedolizumab, upadacitinib demonstrated again a more effective (QALY gains: 0.784, 0.697, 0.514, 0.723, and 0.719, respectively) and cost-effective (ICERs: €16,396, €13,661, €17,074, €10,975, and €13,881, respectively) profile. The probabilistic and deterministic sensitivity analyses as well as scenario analyses confirmed the robustness of the model results.

CONCLUSIONS: Upadacitinib was estimated to be the most effective and cost-effective treatment among all advanced treatments for moderately to severely active UC in Greece.