Cost-utility analysis of certolizumab pegol in combination with methotrexate in patients with moderate-to-severe active rheumatoid arthritis in Greece

Abstract

We aimed to evaluate the cost-effectiveness of certolizumab pegol (CZP), a pegylated fc-free anti-TNF, as add-on therapy to methotrexate (MTX) versus etanercept, adalimumab, or golimumab in patients with moderate-to-severe active rheumatoid arthritis (RA) not responding to the conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). A Markov model (6-month cycle length) assessed health and cost outcomes of CZP versus other anti-TNFs recommended for RA in Greece over a patient's lifetime. Following discontinuation of first-line anti-TNF, patients switched to second anti-TNF and then to a biologic with another mode of action. Sequential use of csDMARDs followed third biologic. Clinical data and utilities were extracted from published literature. Analysis was conducted from third-party payer perspective in Greece. Costs (drug acquisition, administration, monitoring, and patient management) were considered for 2014. Results presented are incremental cost-effectiveness ratios (ICERs) per quality-adjusted life year (QALY). Probabilistic sensitivity analysis (PSA) ascertained robustness of base-case findings. Base-case analysis indicated that CZP+MTX was more costly and more effective compared with Etanercept+MTX (base-case ICER: €3,177 per QALY), whilst versus adalimumab/golimumab, CZP was dominant (less costly, more effective). For all comparisons, CZP treatment resulted in greater improvements in life expectancy and QALYs. PSA indicated that at the willingness-to-pay threshold of €34,000/QALY, CZP+MTX was associated with a 71.6, 97.9, or 99.2% probability of being cost-effective versus etanercept, golimumab, or adalimumab, respectively, in combination with MTX. This analysis demonstrates CZP+MTX to be a cost-effective alternative over Etanercept+MTX and a dominant option over Adalimumab+MTX and Golimumab+MTX for management of RA in Greece.

Cost-utility analyses of targeted immunomodulators in rheumatoid arthritis: systematic review

“…Of the 31 models included in this review, 25 studies were published in peer-reviewed journals 5,[14][15][16][17][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] , five of them were NICE technology appraisals [11][12][13]40,41 , and two models were identified from the gray literature. 42,43 Table 1 provides an overview of each profiled publication.…”

“…14,15,[25][26][27][28][29]42,43 Of the US models, five of them were sponsored by pharmaceutical companies, two of them by academic consortia, and one each was sponsored by an HTA body or an analytics company. Among the other countries, Greece, 16,30 and South Korea 31,32 had two models each, while Colombia, 33 Germany 34 , Iran, 35 Italy, 36 the Netherlands, 37 Norway, 38 Serbia, 39 Spain, 17 and Taiwan 44 had one model each.…”

“…All models focused on evaluating the CU of one or more new or previously-introduced interventions, with four models of tocilizumab, 22,29,34,38 four of tofacitinib, 13,14,16,17 three each of sarilumab, 12,15,26 and certolizumab, 30,39,41 two of adalimumab 5,33 and etanercept, 27,31 and one each of abatacept, 41 baricitinib, 11 and rituximab. 35 Six studies evaluated specific sequences of TIMs, 23,27,28,36,41,43 while four studies each evaluated multiple drugs within a class.…”

“…[11][12][13]15,23,24,26,27,40 The remaining 11 (35%) models were set up as Markov cohort models. 16,27,[30][31][32][33][34][37][38][39]41,42 A higher proportion of CU models published from January 2017 to June 2019 were patient-level simulation models (80%) compared to models published from January 2013 to December 2016 (50%), suggesting an increasing preference for this approach. One commonly-referenced patient-level simulation was the model used by NICE in its 2016 review of all RA therapies available at the time of analysis, 40 which since its publication has been adopted by researchers both affiliated 24 and unaffiliated 15,27 with the authors of the NICE review.…”

“…With the launch of new RA treatments such as tofacitinib, baricitinib, upadacitinib, and sarilumab, 10 economic models have been developed and published to analyze their CU in the context of existing and other novel treatments, [11][12][13][14][15][16][17] with the majority of these developed by either manufacturers or health technology assessment (HTA) agencies. The introduction of new RA treatments, along with their CU models, warrant an updated literature review to identify advances in economic models which could be used to inform future CU modeling in RA.…”