Budget impact analysis of sarilumab for the treatment of rheumatoid arthritis in patients with an inadequate response to conventional synthetic DMARD or TNF inhibitor therapies

Abstract

ObjectiveTo estimate the 5-year budget impact (BI) on a US health plan of introducing sarilumab – a human immunoglobulin G1 anti-IL-6 receptor α monoclonal antibody – as combination treatment with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or monotherapy in patients with moderate-to-severe rheumatoid arthritis (RA).MethodsBI analysis was conducted from a commercial payer perspective. Treatment-eligible populations included adult patients with moderate-to-severe RA and inadequate response (IR) to csDMARDs or tumor necrosis factor (TNF)-α inhibitors-IR. All licensed biologic treatments recommended by the American College of Rheumatology guidelines were included.ResultsFor a hypothetical plan of one million members, 409 csDMARD-IR and 345 TNF-IR patients were annually eligible for combination therapy and 226 csDMARD and TNF-IR patients for monotherapy with sarilumab. Based on 2018 US direct treatment costs, the introduction of sarilumab was estimated to save $526,424, $322,637 and $264,306 over 5 years for csDMARD-IR combination therapy patients, TNF-IR combination therapy patients, and csDMARD-IR/TNF-IR monotherapy patients, respectively. As sarilumab absorbed a greater market share over the horizon, annual savings increased from years 1 to 5, $28,610 (−0.14%) to $194,646 (−0.83%) in csDMARD-IR, $16,986 (−0.11%) to $120,893 (−0.67%) in TNF-IR, and $14,256 (−0.13%) to $98,040 (−0.79%) in monotherapy. One-way sensitivity analyses revealed that the model was most sensitive to variations in sarilumab adherence.ConclusionTotal cost savings of introducing sarilumab to a health-care plan accrued from years 1 to 5, attributable to the lower treatment cost, stable dosing paradigm, and price parity for the two available doses (150 and 200 mg every 2 weeks) compared with alternative biologic DMARDs that have substantial variability in dose titration/schedules.

A Budget Impact and Cost Per Additional Responder Analysis for Baricitinib for the Treatment of Moderate-to-Severe Rheumatoid Arthritis in Patients with an Inadequate Response to Tumor Necrosis Factor Inhibitors in the USA

“…Two prior BIMs related to the TNFi-IR population were published before the availability of baricitinib. The first BIM estimated the 5-year budget impact of sarilumab to US healthcare commercial payers by considering a patient population with moderate-to-severe RA and IR to csDMARDs or TNFis [49]. Overall, the analysis found that sarilumab was cost saving with a lower treatment cost and consistent dosing.…”

“…First, AEs have not been found to be significant model drivers in previous RA health technology assessments and have sometimes been excluded given the assumption that there is no difference in the safety profiles of bDMARDs [48]. Second, a previously published BIM in RA excluded AEs due to heterogeneity in AE reporting [49]. Finally, even if AEs were included, the RA-BEACON trial results show that the impact would be low [6].…”

A budget impact analysis for making treatment decisions based on anti-cyclic citrullinated peptide (anti-CCP) testing in rheumatoid arthritis

“…An annual RA prevalence rate of 0.5% 19 was applied to the hypothetical 1 million member health plan and estimated that 65.5% of RA patients had moderate-to-severe disease activity 20 . We estimated 88.4% of patients used disease-modifying antirheumatoid drug (DMARD) therapy 21 , of whom 39% received conventional synthetic DMARD (csDMARD) and 61% received non-csDMARD therapy 22 . We assumed that non-csDMARD patients had already started a biologic or JAKi therapy whereas patients with inadequate response to csDMARD (36.9% of users) 22 would switch to non-csDMARDs for the first time.…”

“…We estimated 88.4% of patients used disease-modifying antirheumatoid drug (DMARD) therapy 21 , of whom 39% received conventional synthetic DMARD (csDMARD) and 61% received non-csDMARD therapy 22 . We assumed that non-csDMARD patients had already started a biologic or JAKi therapy whereas patients with inadequate response to csDMARD (36.9% of users) 22 would switch to non-csDMARDs for the first time. Thus, we estimated 12.7% of moderate-to-severe RA patients were initiating biologics or JAKi and 53.9% were experienced biologic or JAKi users.…”