Cost-effectiveness modeling of abatacept versus other biologic agents in DMARDS and anti-TNF inadequate responders for the management of moderate to severe rheumatoid arthritis

Abstract

To assess the cost-effectiveness of abatacept compared to different biologic treatment strategies for moderate to severe rheumatoid arthritis based on current medical practices in Canada. A model was constructed to assess the cost-effectiveness of various biologic treatments over a 2-year time horizon, using two effectiveness endpoints: "low disease activity state" (LDAS) and "remission". Abatacept, as first biologic agent after an inadequate response to DMARDs, provides greater treatment success rate for achieving LDAS (29.4% versus 15.6%) and remission (14.8% versus 5.2%), and appears significantly more cost-effective compared to the sequential use of anti-TNF agents (p<0.001). Abatacept, as second biologic agent after an inadequate response to one anti-TNF agent, provides greater treatment success rate for achieving LDAS (17.1% versus 10.2%) and remission (7.4% versus 3.9%) and appears significantly more cost-effective compared to the sequential use of anti-TNF agents (p<0.001). Abatacept is a cost-effective strategy in patients with an inadequate response to DMARDs or to one anti-TNF agent.

Assessing Efficacy, Safety and Tolerability of Rituximab for Rheumatoid Arthritis: Meta-Analyses of Randomized Controlled Trials

“…There are also patients who present intolerability to these drugs. Both circumstances lead to the failure of therapy (8,21). In these cases, other biological agents can be used such as rituximab and abatacept.…”

“…E há pacientes que apresentam intolerabilidade a essas drogas. Ambas as circunstâncias levam à falha terapêutica (8,21). Nesses casos, outros agentes biológicos, como rituximabe e o abatacepte, podem ser utilizados.…”

“…O rituximabe é um anticorpo monoclonal quimérico contra células CD20 humanas; ele leva à depleção de células B CD20 positivas. O rituximabe mostrou-se seguro e eficaz para pacientes com resposta inadequada a antagonistas do TNF e metotrexato em alguns estudos clínicos controlados randomizados (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). O objetivo deste estudo é gerar evidências atualizadas da eficácia, segurança e tolerabilidade do rituximabe para o tratamento da artrite reumatoide.…”

“…Rituximab is a chimeric monoclonal antibody against human-CD20; it leads to rapid depletion of CD20 positive B cells. The rituximab was shown to be safe and efficient for patients with inadequate response to TNF antagonists and methotrexate in some randomized clinical controlled trials (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). The objective of this study is to provide up-to-date evidence of the efficacy, safety and tolerability of rituximab in the treatment of rheumatoid arthritis.…”

Health Economic Modelling of Treatment Sequences for Rheumatoid Arthritis: A Systematic Review

“…[31] The four individual sampling models explicitly modelled sequential treatments and all fully met the Drummond estimated that, adjunct to methotrexate, folic acid was dominated by placebo, and folinic acid dominated placebo. [24] In the seven studies (50%) evaluating the economic impact of bDMARDs in patients with recent-onset RA, the general conclusion was that bDMARDs added both incremental costs and incremental benefits to cDMARD [38,44,[48][49][50]68,[70][71][72] with four using low disease activity score (LDAS) or remission as the unit of effect, [44,50,70,71] two with ACR70 weighted response, [48,49] and one study using per patient improved, [38] one HAQ improvement, [68] and one DAS improvement. [72] Two studies (5%) were cost consequence analyses (CCA's), [57,63] and two studies (5%) were cost minimisation analyses (CMA's).…”