Teprotumumab in Thyroid Eye Disease: A comparative economic study of treatment cost versus quality of life and clinical outcomes
Author: Jennifer Ding
Base Hospital / Institution: Imperial College London, United Kingdom
ePoster presentation
Abstract ID: 24-171
Purpose
Despite the debilitating and disfiguring impact of thyroid eye disease (TED), few effective therapies are available. Teprotumumab — a monoclonal antibody — is the only FDA-approved medication for TED. However, the high cost of Teprotumumab remains a major barrier to achieving clinician and patient buy-in. We aim to compare the relative cost of Teprotumumab with other TED treatments in the context of randomised controlled trial (RCT)-derived outcomes.
Methods
Based on 2021 EUGOGO guidelines and current UK practice, 5 treatment modalities were selected for comparison: Teprotumumab, intravenous methylprednisolone (IVMP), mycophenolate mofetil (MMF), combined IVMP and MMF (IVMP+MMF), and orbital radiotherapy (ORT). A comprehensive search of 5 databases was conducted from January 1st 2000 until April 6th 2024 for RCTs. Reference treatment costs were extracted from an international consensus statement. Treatment costs were compared against 4 parameters: ΔGO-QOL, Δproptosis, % of patients improving in diplopia, % serious adverse events.
Results
In total, 672 patients from 12 RCTs were included for analysis. Overall, the pooled economic benefit was the lowest for Teprotumumab, and the greatest for IVMP. MMF had comparable economic benefit to IVMP, but was 48% more cost-efficient in achieving proptosis improvement. Per unit improvement in GO-QOL, the mean cost of Teprotumumab was 793 times higher than IVMP (cost/ΔGO-QOL: €17,433 v.s. €22), 108 times that of ORT, and 45 times that of IVMP+MMF. The cost per 1 mm reduction in proptosis using Teprotumumab was 313 times higher than that of MMF, 212 times that of IVMP, 19 times that of ORT, and 12 times that of IVMP+MMF. For diplopia, the cost per 1% of patients achieving improvement with Teprotumumab was 161 times the mean cost for IVMP, MMF, and ORT.
Conclusion
This economic analysis showed that Teprotumumab may possess a lower level of clinical benefit/€1 compared to other conventional TED treatments. Future trials assessing retreatment rates, cost of Teprotumumab monitoring, and patient satisfaction, are warranted to address current gaps in economic evaluation.
Additional Authors
There are no additional authors to display.
