Cost-Effectiveness Modelling of Sequential Biologic Strategies for the Treatment of Moderate to Severe Rheumatoid Arthritis in Finland



K Puolakka1, H Blåfield2, M Kauppi3, R Luosujärvi4, R Peltomaa4, T Leikola-Pelho5, K Sennfalt6, A Beresniak*, 7, 8
1 Lappeenranta Central Hospital, Lappeenranta, Finland
2 Seinäjoki Central Hospital, Seinäjoki, Finland
3 Rheumatism Foundation Hospital, Heinola, Finland
4 Helsinki University Central Hospital, Helsinki, Finland
5 Bristol-Myers Squibb, Helsinki, Finland
6 Bristol-Myers Squibb, Stockholm, Sweden
7 Data Mining International, Geneva, Switzerland
8 Paris-Descartes University, Paris, France


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© Puolakka et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Data Mining International, Route de l’Aéroport, 29-31, Case Postale 221, CH-1215 Geneva 15, Switzerland; Tel: + 41 22 799 34 00; Fax: + 41 22 788 38 50; E-mail: aberesniak@datamining-international.com


Abstract

Objective:

The main objective was to compare the cost-effectiveness of therapeutic options in moderate or severe rheumatoid arthritis (RA) when a clinical response to a first TNF-blocker, either etanercept (ETA), adalimumab (ADA), or infliximab (INF), is insufficient.

Methods:

Effectiveness criteria were defined as remission (RS), low disease activity (LDAS), and moderate to high disease activity (MHDAS). Cost-effectiveness was derived as cost per day in RS and in LDAS using simulation modelling to assess six sequential biologic strategies over 2 years. Each sequential treatment strategy was composed of three biologic agents and included a first anti-TNF agent, ETA, ADA or INF, followed by either abatacept (ABA) or rituximab (RTX) as a second therapeutic option in case of an insufficient response, followed by another anti-TNF agent in case of further insufficient response.

Results:

Over two years and taking into account biologic costs, the following estimated mean costs per day in RS and LDAS were respectively of €829 and €428 for the biologic sequence composed of ADA-ABA-ETA, €1292 and €516 for the sequence ADA-RTX-ETA, €829 and €429 for the sequence ETA-ABA-ADA, €1292 and €517 for the sequence ETARTX- ADA, €840 and €434 for the sequence INF-ABA-ETA, and €1309 and €523 for the sequence INF-RTX-ETA.

Conclusion:

The treatment sequences including ABA as the second biologic option appear more cost-effective than those including RTX in a patients with moderate to severe RA and an insufficient response to a first anti-TNF agent.

Keywords: Cost-effectiveness, rheumatoid arthritis, biologics, modelling..