OBJECTIVES: In moderate-to-severe ulcerative colitis (UC), use of advanced therapies (AT) often depends on access policies requiring tumor necrosis factor inhibitors (TNFi) as first-line therapy. This study evaluated how the positioning of ozanimod, a recently approved AT, impacts disease control and costs in UC.

METHODS: A decision-tree model was constructed with current lines (L) of therapy where ozanimod is available only as 2L or 3L option or as part of a basket with tofacitinib and/or ustekinumab. The model simulated ozanimod being added to current 1L TNFi basket of infliximab and adalimumab or replacing the 1L biologics basket of infliximab, adalimumab, vedolizumab, and/or ustekinumab. Outcomes estimated average time on therapy (ToT), endoscopic improvement (EI), mucosal healing (MH), corticosteroid-free remission (CSR), symptomatic remission (SR), cost per ToT, and treatment-related costs associated with receiving 1–3L AT. Switching resulted from relapse or adverse events. Clinical inputs for ozanimod were based on the True North clinical trial and validated with open-label extension data and data from a matching-adjusted indirect comparison for the comparators, stratified by TNFi exposure. Cost inputs were derived from published literature and national databases.

RESULTS: Addition of ozanimod to 1L TNFi basket increased 1L ToT by 0.26 years, MH rates by 8%, SR by 4%, and CSR by 5%. Replacing current 1L biologics with ozanimod extended 1L ToT by 0.16–0.22 years and increased MH rates by 24–26%, SR by 16%, and CSR by 12%. Compared to later-line use of ozanimod, 1L ozanimod was associated with a lower or similar total cost per ToT (difference of −$12,000 to $2800), while EI rates and disease-related costs did not change.

CONCLUSIONS: Primarily driven by efficacy and safety, these results suggest that positioning ozanimod early in UC treatment may lead to improvements in ToT and better clinical outcomes with minimal impact on costs.