Evaluation of the Optimal Position for Vedolizumab in the Japanese Treatment Paradigm for Ulcerative Colitis Using Markov Modeling

BACKGROUND: This analysis assessed the optimal position of vedolizumab for Japanese patients with ulcerative colitis. METHODS: A Markov model was used to evaluate the performance of 4 treatment algorithms of vedolizumab position: after azathioprine (Algorithm 1); after tacrolimus/cytapheresis (Algorithm 2); after a first anti-tumor necrosis factor alpha (anti-TNFα) (Algorithm 3); and after a second anti-TNFα before colectomy (Algorithm 4). RESULTS: Algorithm 1 was the dominant strategy, with an incremental benefit over the other algorithms of 0.028–0.031 quality-adjusted life years. CONCLUSIONS: This simulation predicts that introducing vedolizumab immediately after a thiopurine and before other therapies will provide most benefit.