The CADTH clinical review findings indicate that budesonide 1 mg is effective for inducing clinicopathologic remission in patients with active eosinophilic esophagitis (EoE) after six weeks of treatment, though the results are more pronounced for clinicohistologic remission than for the symptomatic remission component. The CADTH clinical review also noted uncertainty in the meaningfulness of the observed improvement in health-related quality of life. No information was available on the comparative effectiveness of budesonide 1 mg with treatments that are currently used for EoE in Canada.
Due to structural limitations with the sponsor’s model, CADTH was unable to estimate the cost-effectiveness of budesonide 1 mg over a relevant time horizon or compared with relevant comparators currently used for the treatment of EoE in Canada. CADTH was also unable to estimate the cost-effectiveness of budesonide 1 mg in the full population represented by the Health Canada indication, as there is a gap in evidence for patients with EoE who have not been shown to be refractory to proton pump inhibitors (PPIs). Furthermore, the identified limitations also highlighted that the sponsor’s model is inadequate to estimate the cost-effectiveness of budesonide 1 mg over the submitted one-year time horizon.
In order to provide some economic information, CADTH estimated the cost-effectiveness of budesonide 1 mg compared with no treatment over a single treatment and assessment period for an EoE flare (considered to range from six to 12 weeks). Based on a time horizon of 12 weeks, with a maximum duration of therapy of six weeks, budesonide 1 mg was associated with an incremental cost-effectiveness ratio (ICER) of $24,422 per quality-adjusted life-year (QALY) compared with no treatment. If a shorter time horizon (six weeks) or an increased maximum duration of budesonide 1 mg treatment (12 weeks) is considered, the ICER increases to $74,129 per QALY and $31,133 per QALY, respectively. The cost-effectiveness of budesonide 1 mg compared with other therapies used in the treatment of EoE in Canada over any time horizon is unknown.
At the submitted price, the drug acquisition cost of budesonide 1 mg orodispersible tablets is $462 for a six-week course of therapy, which is more expensive than other pharmacological therapies currently in use in Canada for the treatment of EoE.
Funding: CADTH receives funding from Canada’s federal, provincial, and territorial governments, with the exception of Quebec.
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