Cost-effectiveness of avacopan for ANCA-associated vasculitis in China.

OBJECTIVES

To evaluate the cost-effectiveness of avacopan plus immunosuppressants versus glucocorticoid (GC)-based regimens for adults with granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA) in China, and to estimate the maximum avacopan unit price consistent with willingness-to-pay (WTP) thresholds.

METHODS

A nine-state Markov model (active disease; three remission states; three relapse states; end-stage renal disease [ESRD]; death) was developed from the Chinese healthcare system perspective. Baseline characteristics were derived from the ADVOCATE trial. The intervention was avacopan plus cyclophosphamide (CYC) or rituximab (RTX) with reduced-dose GCs; the comparator was CYC/RTX plus standard GCs. Treatment shares followed trial allocation (35.2% CYC; 64.8% RTX). Outcomes included total costs, life-years (LYs), quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios (ICERs), using a WTP threshold of one time China's 2024 GDP per capita per QALY. Uncertainty was assessed through one-way, probabilistic, and scenario analyses. Threshold price analyses back calculated the avacopan unit price at WTPs of one time, 1.2 times, and 1.5 times GDP per capita.

RESULTS

Avacopan increased QALYs (5.81 vs. 5.26) and LYs (8.25 vs. 7.77) and increased total costs ($73,478 vs. $70,110), yielding an ICER of $6,146/QALY. At a WTP of $13,445/QALY, avacopan was cost-effective; results were robust in sensitivity and scenario analyses. The maximum cost-effective price was $11.12-$12.70 per 10 mg at WTPs of 1.0-1.5 times GDP per capita.

CONCLUSIONS

Avacopan-based regimens are cost-effective versus GC-based therapy for GPA/MPA in China and support value-based pricing of $11.12-$12.70 per 10 mg.