Both belimumab and voclosporin improve clinical outcomes in patients with lupus nephritis, but the medications differ in their cost-effectiveness, according to a recent analysis.

Investigators created a cost-effectiveness model for the novel treatments using data from the landmark trials demonstrating their clinical effectiveness: BLISS-LN, AURA-LV, and AURORA. Compared with using standard of care immunosuppression alone, the costs per gained quality-adjusted life year (QALY) for add-on belimumab, an intravenous B-lymphocyte inhibitor, were $95,269 for intravenous administration (or $70,077 for subcutaneous administration) and $150,344 for add-on voclosporin, an oral calcineurin inhibitor, James Fotheringham, MBChB, PhD, of The University of Sheffield, Sheffield, UK, and colleagues reported in the Clinical Journal of the American Society of Nephrology. The model was based on a projected use of 3 years for responders and 1.5 years for nonresponders. The investigators incorporated projected rates of complete response, partial response, kidney failure, and death using data from the respective trials.

The probability of each drug being cost-effective at a threshold of $150,000 per QALY was 69% for belimumab and 49% for voclosporin, Dr Fotheringham’s team reported. From a societal perspective, the incremental cost-effectiveness ratio was $66,000 per QALY for belimumab and $133,000 per QALY for voclosporin.

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Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.


Mandrik O, Fotheringham J, Ren S, et al. The cost-effectiveness of belimumab and voclosporin for patients with lupus nephritis in the United States. Clin J Am Soc Nephrol. Published online February 3, 2022. doi:10.2215/CJN.13030921

Onno Teng YK, Rabelink TJ. Will new treatment options for lupus nephritis be affordable? Clin J Am Soc Nephrol. Published online February 3, 2022. doi:10.2215/CJN.00690122