Telitacicept versus belimumab for the treatment of systemic lupus erythematosus: a network meta-analysis and cost-effectiveness analysis

OBJECTIVES: Both telitacicept and belimumab are approved for treating active systemic lupus erythematosus (SLE) in China. However, the economic value of these two drugs is unclear. Therefore, this study aims to evaluate the cost-effectiveness of telitacicept versus belimumab in SLE from the perspective of Chinese society. METHODS: The network meta-analysis (NMA) and cost-effectiveness analysis included the efficacy and safety of patients from five randomised clinical trials. A microsimulation model was constructed to compare the cost-effectiveness of telitacicept versus belimumab in SLE. The model integrated short-term efficacy and long-term prognosis to simulate the patient's lifetime. Outcome measures included life years (LYs), quality-adjusted LYs (QALYs), total healthcare costs and the incremental cost-effectiveness ratio (ICER). The robustness of the model was assessed through sensitivity analyses. RESULTS: The NMA suggested the response rate risk ratios (RRs) of telitacicept compared with belimumab were 1.200 (95% CI 0.760 to 1.910). When this RR was used as the model input, the results of the baseline analysis showed an increase in the effectiveness of 0.506 QALYs and an increase in the total cost of US$3026 for telitacicept as compared with belimumab, with an ICER of US$5984 per QALY gained. At a willingness-to-pay (WTP) threshold of US$40 344 per QALY, the probability that telitacicept would be cost-effective compared with belimumab was 99.1%. CONCLUSION: Although the comparative efficacy between telitacicept and belimumab remains statistically inconclusive, cost-effectiveness modelling suggests that telitacicept plus standard therapy is likely to be a cost-effective treatment option for patients with SLE in China under current WTP thresholds.