Cost-Effectiveness Analysis of Abatacept Compared with Adalimumab on Background Methotrexate in Biologic-Naive Adult Patients with Rheumatoid Arthritis and Poor Prognosis

Alemao, E.; Johal, Sukhvinder; Al, Maiwenn; Mölken, Maureen Rutten-van

doi:10.1016/j.jval.2017.05.020

Cited by 13 publications

(18 citation statements)

References 37 publications

(74 reference statements)

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“…Incorporation of subgroups based on prognostic factors ranked high on the prioritization order as this is relatively straightforward. In addition, recent cost effectiveness analyses have demonstrated the importance of incorporation of subgroups as these patients may have characteristics which are potentially effect modifiers [ 29 , 30 ]. However, these analyses are still limited and further work needs to be done to understand and define RA subgroups with combinations of prognostic factors.…”

Section: Discussionmentioning

confidence: 99%

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Conceptual model for the health technology assessment of current and novel interventions in rheumatoid arthritis

Alemao

Boonen

et al. 2018

PLoS ONE

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The objective of this study was to evaluate current approaches to economic modeling in rheumatoid arthritis (RA) and propose a new conceptual model for evaluation of the cost-effectiveness of RA interventions. We followed recommendations from the International Society of Pharmacoeconomics and Outcomes Research-Society of Medical Decision Making (ISPOR-SMDM) Modeling Good Research Practices Task Force-2. The process involved scoping the decision problem by a working group and drafting a preliminary cost-effectiveness model framework. A systematic literature review (SLR) of existing decision-analytic models was performed and analysis of an RA registry was conducted to inform the structure of the draft conceptual model. Finally, an expert panel was convened to seek input on the draft conceptual model. The proposed conceptual model consists of three separate modules: 1) patient characteristic module, 2) treatment module, and 3) outcome module. Consistent with the scope, the conceptual model proposed six changes to current economic models in RA. These changes proposed are to: 1) use composite measures of disease activity to evaluate treatment response as well as disease progression (at least two measures should be considered, one as the base case and one as a sensitivity analysis); 2) conduct utility mapping based on disease activity measures; 3) incorporate subgroups based on guideline-recommended prognostic factors; 4) integrate realistic treatment patterns based on clinical practice/registry datasets; 5) assimilate outcomes that are not joint related (extra-articular outcomes); and 6) assess mortality based on disease activity. We proposed a conceptual model that incorporates the current understanding of clinical and real-world evidence in RA, as well as of existing modeling assumptions. The proposed model framework was reviewed with experts and could serve as a foundation for developing future cost-effectiveness models in RA.

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Section: Discussionmentioning

confidence: 99%

“…However, most of these models do not report incremental cost-effectiveness ratios (ICERs) according to important subgroups. Recent studies have evaluated ICER within a limited number of RA subgroups [ 29 , 30 ].…”

Section: Introductionmentioning

confidence: 99%

Conceptual model for the health technology assessment of current and novel interventions in rheumatoid arthritis

Alemao

Boonen

et al. 2018

PLoS ONE

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“…There are some clinical studies that directly compared abatacept with adalimumab (both on background treatment with methotrexate), which indicate some benefits of abatacept over the TNF-α inhibitor [273][274][275]: two AMPLE studies (Abatacept versus Adalimumab Comparison in Biologic-Naïve RA Patients with Background Methotrexate) showed that the overall disease outcome, improvement on tender and swollen joint count (69.4% ± 2.9% improvement in swollen joint count for abatacept vs. 69.3% ± 2.9% for adalimumab), physician's global assessment (63.6% ± 4.8% for abatacept vs. 62.8% ± 4.7% for adalimumab), CRP levels, pain (mean ± SEM improvements in pain at year 2: 53.7% ± 6.2% for abatacept vs. 38.5% ± 6.1% for adalimumab), fatigue, as well as ability to perform both work and daily activities were comparable between abatacept and adalimumab [273,274]. Moreover, the improvement in ACR50 response rates over 2 years was also similar (44.7% for abatacept vs. 46.6% for adalimumab) [274].…”

Section: Inhibitors Of Co-stimulationmentioning

confidence: 99%

“…However, there were less discontinuations in the abatacept group compared with adalimumab due to adverse effects (3.8% for abatacept vs. 9.5% for adalimumab), a lower frequency of serious adverse events (1.6% vs. 4.9%) and severe infections (0/12 vs. 9/19 patients), as well as reduced occurrence of injection site reactions (4.1% vs. 10.4%) [274]. Economically, abatacept was suggested to be a cost-effective alternative to adalimumab in patients with higher ACPAs by Alemao and colleagues after analyzing 646 randomized patients treated with either abatacept or adalimumab (both in combination with methotrexate treatment) [275].…”

Section: Inhibitors Of Co-stimulationmentioning

confidence: 99%

Update on the Pathomechanism, Diagnosis, and Treatment Options for Rheumatoid Arthritis

Lin

Anzaghe

Schülke

2020

Cells

582

376

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Rheumatoid arthritis (RA) is an autoimmune disease that involves multiple joints bilaterally. It is characterized by an inflammation of the tendon (tenosynovitis) resulting in both cartilage destruction and bone erosion. While until the 1990s RA frequently resulted in disability, inability to work, and increased mortality, newer treatment options have made RA a manageable disease. Here, great progress has been made in the development of disease-modifying anti-rheumatic drugs (DMARDs) which target inflammation and thereby prevent further joint damage. The available DMARDs are subdivided into (1) conventional synthetic DMARDs (methotrexate, hydrochloroquine, and sulfadiazine), (2) targeted synthetic DMARDs (pan-JAK- and JAK1/2-inhibitors), and (3) biologic DMARDs (tumor necrosis factor (TNF)-α inhibitors, TNF-receptor (R) inhibitors, IL-6 inhibitors, IL-6R inhibitors, B cell depleting antibodies, and inhibitors of co-stimulatory molecules). While DMARDs have repeatedly demonstrated the potential to greatly improve disease symptoms and prevent disease progression in RA patients, they are associated with considerable side-effects and high financial costs. This review summarizes our current understanding of the underlying pathomechanism, diagnosis of RA, as well as the mode of action, clinical benefits, and side-effects of the currently available DMARDs.

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“…Treatment strategies include pain-relieving drugs and anti-inflammatory medications that slow joint damage, combined with physical therapies that involve a well-balanced sequence of rest and exercise. In view of better compliance, exercise programs are highly personalized and tailor-made under consideration of the patients' physical abilities, limitations, and needs; [6,7]. It has been reported that RA patients have an increased risk of experiencing functional disability with the prolongation of the course of disease [8].…”

Section: Introductionmentioning

confidence: 99%

Monitoring the Time Course of Disability through a Self-Assessment Instrument "Activity Index" (IA) in RA Patients

Ren¹,

Zhang²,

ZG³

et al. 2018

J Rheum Dis Treat

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Background: Rheumatoid arthritis (RA) is a heterogeneous autoimmune disease whose etiopathogenesis is largely unknown. Available treatments, though effective, are insufficient in so far as there is no cure for a major proportion of patients. In those patients the disease becomes chronic with progressive joint damage, disability, and limitation of participation. Current treatment approaches include pain-relieving drugs and anti-inflammatory medications that slow joint damage, combined with physical therapies involving a well-balanced, highly personalized sequence of rest and exercise. As pain-relief, overall activity, mobility and participation are vital indicators of disability and response to RA treatment, regular patient feedback in this respect is key to a successful monitoring of the long-term effect of therapy. To manage such feedback, we have developed an easyto-use self-assessment tool "Activity Index" (AI) for tablets and smartphones that enables regular assessments of RA improvement and/or deterioration in the patients' home environment. In this normative study we addressed the questions of (1) The AI sensitivity regarding the resolution of small between-patient differences; and (2) The external validity of the AI instrument when compared with "objective" laboratory and x-ray measures and the HAQ disability index.

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Cost-Effectiveness Analysis of Abatacept Compared with Adalimumab on Background Methotrexate in Biologic-Naive Adult Patients with Rheumatoid Arthritis and Poor Prognosis

Abstract: Abatacept is a cost effective alternative to adalimumab in patients with RA with high ACPA levels.

Cited by 13 publications

References 37 publications

Conceptual model for the health technology assessment of current and novel interventions in rheumatoid arthritis

Conceptual model for the health technology assessment of current and novel interventions in rheumatoid arthritis

Update on the Pathomechanism, Diagnosis, and Treatment Options for Rheumatoid Arthritis

Monitoring the Time Course of Disability through a Self-Assessment Instrument "Activity Index" (IA) in RA Patients

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