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Only limited information is available on cost efficacy of the various biological agents used to treat patients with rheumatoid arthritis with intolerance or for whom it would be inappropriate to continue treatment with conventional agents. We estimated the efficacy and treatment costs of monotherapy with biological agents in the treatment of this group of patients.
Data from two previous meta-analyses in the treatment of patients who are intolerant to methotrexate (MTX), or for whom it would be inappropriate to continue treatment with MTX was used. Pharmacoeconomic comparison between biological agents was carried out to estimate the respective cost for the number needed to treat (NNT) compared to placebo using both American College of Rheumatology (ACR) and European League Against Rheumatism (EULAR) criteria. The analysis involved the four agents approved in Italy: adalimumab (ADA), etanercept (ETN), certolizumab pegol (CTZ), and tocilizumab (TCZ). A six-month period was considered sufficient to understand the most important differences in efficacy and treatment costs. Direct medical costs, including pharmacological therapy, administration and monitoring were considered.
Using both ACR and EULAR criteria, TCZ (intravenous [iv]/subcutaneous [sc]) had a lower NNT than the other agents. The difference in NNT observed for ETN was more pronounced with EULAR criteria, whereas in the comparison with ADA, the most sensitive differences were observed with ACR criteria. ETN had the lowest treatment cost (€6402.19), followed by ADA (€6698.84), TCZ sc (€6887.61), and TCZ iv (€7130.83). TCZ sc had the lowest cost for NNT with both ACR and EULAR criteria. The differences compared to ETN and ADA were significant and related with the level of efficacy. Sensitivity analysis confirmed these results.
TCZ is a cost-effective therapeutic option compared to other tumor necrosis factor-α inhibitors (ADA, ETA, CTZ) as first-line monotherapy for patients who are intolerant to MTX, or for whom it is inappropriate to continue treatment with MTX.
Gibofsky A. Overview of epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis. Am J Manag Care. 2012;18(13 Suppl):S295–302. PubMed
Gibofsky A. Epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis: a synopsis. Am J Manag Care. 2014;20(7 Suppl):S128–35. PubMed
Kvien TK. Epidemiology and burden of illness of rheumatoid arthritis. Pharmacoeconomics. 2004;22(2 Suppl 1):1–12. PubMed
Singh JA, Furst DE, Bharat A, Curtis JR, Kavanaugh AF, Kremer JM, et al. 2012 update of the 2008 American College of Rheumatology recommendations for the use of disease-modifying antirheumatic drugs and biologic agents in the treatment of rheumatoid arthritis. Arthritis Care Res (Hoboken). 2012;64(5):625–39. CrossRefPubMedPubMedCentral
Cerra C, Ravasio R, Polcaro F. Il costo dell’Artrite Reumatoide: l’esperienza dell’ASL della Provincia di Pavia. Giornale Italiano di Health Technol Assess. 2009;2(3):111–7. CrossRef
Boonen A, Mau W. The economic burden of disease: comparison between rheumatoid arthritis and ankylosing spondylitis. Clin Exp Rheumatol. 2009;27(4 Suppl 55):S112–7. PubMed
NICE. Rheumatoid arthritis (CG79): full guideline. London, UK: NICE; 2009. http://guidance.nice.org.uk/CG79/Guidance. Accessed 20 Apr 2016.
Thwaites C, Finney A. Rheumatoid arthritis. 2: exploring treatment options to achieve early control and remission. Nurs Times. 2010;106(10):18–20. PubMed
Caporali R, Conti F, Alivernini S, Atzeni F, Seriolo B, Cutolo M, et al. Recommendations for the use of biologic therapy in rheumatoid arthritis: update from the Italian Society for Rheumatology I. Efficacy. Clin Exp Rheumatol. 2011;29(3 Suppl 66):S7–14. PubMed
Nell VP, Machold KP, Eberl G, Stamm TA, Uffmann M, Smolen JS. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford). 2004;43(7):906–14. CrossRef
Conti F, Scrivo R. Il follow-up del paziente con artrite reumatoide di lunga durata. Focus Anno XIV. 2011;1:1–48.
Aletaha D, Smolen J. The simplified disease activity index (SDAI) and the clinical disease activity index (CDAI): a review of their usefulness and validity in rheumatoid arthritis. Clin Exp Rheumatol. 2005;23(5 Suppl 39):S100–8. PubMed
Prevoo ML, van’t Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38(1):44–8. CrossRefPubMed
NICE. Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab and abatacept for rheumatoid arthritis not previously treated with DMARDs or after conventional DMARDs only have failed. Technology appraisal guidance. http://www.nice.org.uk/guidance/ta375 (2016). Accessed Apr 2016.
Orme ME, Macgilchrist KS, Mitchell S, Spurden D, Bird A. Systematic review and network meta-analysis of combination and monotherapy treatments in disease-modifying antirheumatic drug-experienced patients with rheumatoid arthritis: analysis of American College of Rheumatology criteria scores 20, 50, and 70. Biologics. 2012;6:429–64. PubMedPubMedCentral
The AIES working group (coordinated by G. Fattore). Proposta di linee guida per la valutazione economica degli interventi sanitari in Italia. PharmacoEcon Ital Res Artic. 2009;11(2):83–93. CrossRef
Kristensen LE, Christensen R, Bliddal H, Geborek P, Danneskiold-Samsoe B, Saxne T. The number needed to treat for adalimumab, etanercept, and infliximab based on ACR50 response in three randomized controlled trials on established rheumatoid arthritis: a systematic literature review. Scand J Rheumatol. 2007;36(6):411–7. CrossRefPubMed
NICE. Guide to the methods of technology appraisal. 2013. http://www.nice.org.uk/aboutnice/howwework/devnicetech/guidetothemethodsoftechnologyappraisal.jsp. Accessed Oct 2014.
Canadian Agency for Drugs and Technologies in Health. Guidelines for the Economic Evaluation of Health Technologies: Canada rE. http://www.inahta.org/upload/HTA_resources/AboutHTA_Guidelines_for_the_Economic_Evaluation_of_Health_Technologies.pdf. Accessed Oct 2014.
Specialist outpatient healthcare services. Ordinary supplement no. 8 to the Official Gazette. General series no. 23 of 20/01/2013.
Poster presented at ISPOR 18th Annual European Congress, 7–11 November 2015 Milan, Italy.
AIES, Associazione Italiana di Economia Sanitaria. Proposte di linee guida per la valutazione economica degli interventi sanitari. Pharmacoecon Ital Res Artic. 2009;11(2):89–93.
Buckley F, Finckh A, Huizinga TW, Dejonckheere F, Jansen JP. Comparative efficacy of novel DMARDs as monotherapy and in combination with methotrexate in rheumatoid arthritis patients with inadequate response to conventional DMARDs: a network aeta-analysis. J Manag Care Spec Pharm. 2015;21(5):409–23. CrossRefPubMed
Dougados M, Kissel K, Sheeran T, Tak PP, Conaghan PG, Mola EM, et al. Adding tocilizumab or switching to tocilizumab monotherapy in methotrexate inadequate responders: 24-week symptomatic and structural results of a 2-year randomised controlled strategy trial in rheumatoid arthritis (ACT-RAY). Ann Rheum Dis. 2013;72(1):43–50. CrossRefPubMed
Gabay C, Emery P, van Vollenhoven R, Dikranian A, Alten R, Klearman M, et al. Tocilizumab (TCZ) monotherapy is superior to adalimumab (ADA) monotherapy in reducing disease activity in patients with rheumatoid arthritis (RA): 24-week data from the phase 4 adacta trial. Ann Rheum Dis. 2013;71(Suppl 3):152. CrossRef
- Efficacy and Treatment Costs of Monotherapy with bDMARDs in the Treatment of Rheumatoid Arthritis in Patients Intolerant to or Inappropriate to Continue Treatment with Methotrexate
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