Cost-effectiveness of iptacopan for paroxysmal nocturnal hemoglobinuria

Iptacopan, a novel oral Factor B inhibitor, recently obtained FDA approval for treating paroxysmal nocturnal hemoglobinuria, a rare blood disorder characterized by persistent complement-mediated hemolytic anemia. The standard-of-care (SOC) has traditionally relied on complement C5 inhibitors eculizumab and ravulizumab, which are limited by persistent anemia from extravascular hemolysis and requirement for intravenous infusion. Recent publication of phase 3 studies in this arena reinforces iptacopan as an effective anti-complement monotherapy compared with SOC. Given ongoing price negotiations and limited literature showing its cost-ineffectiveness in the anti-C5-treated population, we conducted a comprehensive cost-effectiveness analysis of iptacopan monotherapy in anti-C5-treated patients from the societal perspective, as compared to C5 inhibition. The primary outcomes were the incremental net monetary benefit (iNMB) across a lifetime horizon and the cost-effective maximum monthly threshold price of iptacopan monotherapy compared to the SOC. The secondary outcome was time saved for patients and nurses with the utilization of oral iptacopan therapy. Iptacopan monotherapy and SOC accrued 12.6 and 10.8 QALYs at costs of $9.52 million and $13.5 million, respectively. Iptacopan remained cost-saving across extensive sensitivity and all scenario analyses, including alternative parameterization for anemia resolution and aggregated individual-level utilities and transition probability matrix. Across all probabilistic sensitivity analyses, iptacopan therapy was favored over SOC in 100% of 10,000 Monte Carlo iterations. Cost-saving thresholds for iptacopan versus anti-C5 in are ~1.1, 1.4, and 1.4 in Brazil, Japan, and the United States. Iptacopan monotherapy can improve quality-adjusted life expectancy for patients while saving healthcare costs across jurisdictions.