Assessing the cost-effectiveness of biologic agents for the management of moderate-to-severe rheumatoid arthritis in anti-TNF inadequate responders in Italy: a modelling approach

作者：Cimmino M A; Leardini G; Salaffi F; Intorcia M; Bellatreccia A; Dupont D; Beresniak A^*

来源：Clinical and Experimental Rheumatology, 2011, 29(4): 633-641.

• cost-effectiveness
• modelling
• rheumatoid arthritis
• abatacept
• rituximab

Objective
The objective of this study is to assess cost-effectiveness of different biologic strategies in patients with moderate-to-severe active RA after an insufficient response to anti-TNF agents within the context of the Italian healthcare system.
Methods
Simulation models were developed allowing for potential biologic therapy switch at each 6-month time point in case of an insufficient response to the previous biologic agent. Biologic treatments included etanercept, abatacept, adalimumab rituximab or infliximab. Effectiveness criteria for these models were defined as achieving a state of low disease activity (LDAS) [DAS28 <= 3.2,1 or remission (RS) [DAS28<2.6]. Monte-Carlo simulations were performed for each sequence to manage data variability.
Results
The biologic treatment sequence using abatacept after an insufficient response to a first anti-TNF agent appeared significantly more efficacious over 2 years (102 days in LDAS) compared to rituximab (82 days in LDAS). The sequence using abatacept after 2 anti-TNF agents appeared significantly more efficacious (63 days in LDAS) compared to using a third anti-TNF agent (32 days in LDAS). Mean cost-effectiveness ratios showed significantly lower costs per day in LDAS with abatacept used after one anti-TNF agent (sic376) compared to rituximab (sic456). The sequence using abatacept after 2 anti-TNF agents was also more cost-effective (sic642 per day in LDAS) versus a sequential use of anti-TNF therapies (sic1164 per day in LDAS). All comparisons were confirmed when using the remission effectiveness criteria.
Conclusion
The results of this health economics modelling study suggest that the biologic treatment sequence using abatacept after an insufficient response to a first anti-TNF agent appears significantly more effective and cost-effective versus a similar sequence using rituximab for achieving remission or LDAS. The results also indicate that in the case of an insufficient response to 2 anti-TNF agents, abatacept appears more effective and cost-effective than using a 3(rd) anti-TNF agent.

• 出版日期2011-8