OBJECTIVES: To evaluate cost-effectiveness of belimumab plus standard therapy (ST) versus ST alone for the treatment of adults with active lupus nephritis (LN) in China from a public medical insurance perspective.
METHODS: A Chinese cost-effectiveness model (CEM) was adapted from a global CEM (Markov model).1 CEM structure and inputs were validated by experts. The model was populated with Chinese data where available and supplemented with data from other sources. Population characteristics and treatment effects were based on the BLISS-LN trial.2 Key outputs included incremental costs, life-years, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs), with costs (2022 Chinese Yuan [CNY¥]) and outcomes discounted at 5%. One-way sensitivity analysis (OWSA), probabilistic sensitivity analysis (PSA) and scenario analyses evaluated the robustness of results.
RESULTS: Belimumab plus ST was more effective (incremental QALYs: 0.21) and more costly (incremental cost: CNY¥15,927) than ST alone, leading to an ICER of CNY¥76,817 (0.896 gross domestic product [GDP] per capita). This was considered cost-effective per the willingness-to-pay (WTP) threshold of 1–3 times GDP per capita. OWSA and scenario analysis indicated the parameters most affecting the ICER included mean weight of females, dialysis costs, renal transplant and hospitalization costs in “dialysis dependent” health state, and discount rates. Belimumab plus ST was dominant with a 3% discount rate and was cost-effective for all scenarios except an 8% discount rate. In PSA, belimumab plus ST had a 73.7% probability of being cost-effective.
CONCLUSION: The adapted CEM demonstrated cost-effectiveness of belimumab plus ST versus ST alone for the treatment of adults with active LN in China. Since it did not consider the impact of belimumab on extra-renal disease and steroid-sparing outcomes, these results may underestimate the cost-effectiveness of belimumab for active LN.
