Assessing the Value of Sarilumab Monotherapy for Adults with Moderately to Severely Active Rheumatoid Arthritis: A Cost-Effectiveness Analysis

Abstract

BACKGROUND: Rheumatoid arthritis is associated with a societal burden greater than $39 billion annually. Novel treatments, known as targeted immune modulators (TIMs), are expensive but effective, producing improvements in response rates compared with conventional diseasemodifying antirheumatic drugs (cDMARDs). Sarilumab, a TIM approved in 2017, shows superior improvements compared with cDMARDs and produced significantly greater likelihood of achieving response and improvement in the Health Assessment Questionnaire Disability Index than adalimumab monotherapy. Although sarilumab monotherapy has shown improvements over cDMARDs and the TIM market leader adalimumab, treatment with sarilumab is costly, with an annual wholesale acquisition cost of $39,000. OBJECTIVE: To estimate the lifetime cost-effectiveness of starting treatment with sarilumab monotherapy for adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response to cDMARDs. What this study addsnet prices led to cost-effectiveness estimates above commonly cited thresholds. When compared with the market leader, sarilumab achieved favorable value. This evaluation informs stakeholders of the value of sarilumab and its alternatives to promote high value practices in health care.

Changes in List Prices, Net Prices, and Discounts for Branded Drugs in the US, 2007-2018

“…We obtained 2007-2018 list and net prices for branded medications from the investment firm SSR Health, 6 which had been previously used in peer-reviewed literature. [7][8][9][10] Every quarter, the investment firm estimates what it terms net prices as the ratio between company-reported sales for each product (numerator) and the number of units sold in the US (denominator), obtained from Symphony Health. 11 Data on the number of units sold include retail pharmacy, inpatient, and other clinical settings.…”

Cost-Effectiveness of Sarilumab Added to Methotrexate in the Treatment of Adult Patients with Moderately to Severely Active Rheumatoid Arthritis Who Have Inadequate Response or Intolerance to Tumor Necrosis Factor Inhibitors

“…Two other cost-effectiveness analyses have found sarilumab monotherapy to be cost-effective compared with comparative treatment in patients with RA but in an earlier setting (i.e., patients intolerant to or inadequate responders to csDMARDs). 56,57 Limitations Some limitations of this study must be considered. There is inherent uncertainty in the evidence regarding short-term treatment response rates and long-term benefits of bDMARDs.…”

Comparative Cost-Effectiveness of Tofacitinib With Continuing Conventional Synthetic Disease-Modifying Anti-Rheumatic Drugs for Active Rheumatoid Arthritis in South Korea

“…Several randomized controlled trials (RCTs) have demonstrated a higher efficacy of tofacitinib [2][3][4] and bDMARDs [5][6][7][8] compared with csDMARDs in patients with moderate to severe RA. However, in real-world clinical practice, patients continue to use csDMARDs for various reasons, including safety concerns, cost considerations, and patient preference [9,10].…”