OBJECTIVES: To evaluate the costs and health outcomes of belimumab plus standard therapy (ST) versus ST alone for the treatment of adults with active lupus nephritis (LN) in Canada from a healthcare payer perspective.
METHODS: A cohort-level Markov model was developed with health states classified by estimated glomerular filtration rate (eGFR; mL/min/1.73 m2) and dialysis/renal transplant status. Population characteristics and treatment effects were based on the BLISS-LN trial. Transition probabilities were informed by published sources. Long-term renal function was based on eGFR slope during BLISS-LN. ST comprised intravenous cyclophosphamide induction followed by azathioprine maintenance (CYC→AZA) or mycophenolate mofetil (MMF) alone. Cost (2021/2022 $CAD) and health outcomes were discounted at 1.5%. One-way sensitivity and scenario analyses were performed to evaluate robustness of results. The base-case analysis was probabilistic. Pairwise comparisons were performed for belimumab plus CYC→AZA versus CYC→AZA and belimumab plus MMF versus MMF alone.
RESULTS: Belimumab plus CYC→AZA and belimumab plus MMF were more costly and more effective than CYC→AZA and MMF alone, with mean incremental cost-utility ratios (ICURs) of $515,277 and $345,269, respectively. Patients receiving belimumab incurred lower disease management costs (versus CYC→AZA: –$57,909; versus MMF: –$84,151), mainly due to a reduction in hospitalizations and dialysis/renal transplants, and lower flare management (versus CYC→AZA: –$2,554; versus MMF: –$2,658). Overall, belimumab was associated with increased quality-adjusted life years (QALYs) (versus CYC→AZA: 0.41; versus MMF: 0.57) due to reduction in disease progression (versus CYC→AZA: +0.28; versus MMF: +0.47), reduced flares (versus CYC→AZA: +0.08; versus MMF: +0.08), and steroid sparing (versus CYC→AZA: +0.06; versus MMF: +0.02).
CONCLUSIONS: Although belimumab’s cost-effectiveness results did not align with conventional willingness-to-pay thresholds in Canada, belimumab was associated with a reduction in disease management due to slower disease progression, steroid sparing, and reduced disease flares.
