Cost-utility analysis of de-escalating biological disease-modifying anti-rheumatic drugs in patients with rheumatoid arthritis

Abstract

Objective Recent guideline updates have suggested de-escalating DMARDs when patients with rheumatoid arthritis achieve remission or low disease activity. We aim to evaluate whether it is cost-effective to de-escalate the biological form of DMARDs (bDMARDs). Methods Using a Markov model, we performed a cost-utility analysis for RA patients on bDMARD treatment. We compared continuing treatment (standard care) to a tapering approach (i.e., an immediate 50% dose reduction), withdrawal (i.e., an immediate 100% dose reduction) and tapering followed by withdrawal of bDMARDs. The parametrization is based on a comprehensive literature review. Results were computed for 30 years with a cycle length of three months. We applied the payer's perspective for Germany and conducted deterministic and probabilistic sensitivity analyses. Results Tapering or withdrawing bDMARD treatment resulted in ICERs of €526,254 (incr. costs-78,845, incr. QALYs-0.1498) or €216,879 (incr. costs-€121,691, incr. QALYs-0.5611) compared to standard care. Tapering followed by withdrawal resulted in a loss of 0.4354 QALYs and savings of €107,969 per patient, with an ICER of €247,987. Deterministic sensitivity analysis revealed that our results remained largely unaffected by parameter changes. Probabilistic sensitivity analysis suggests that tapering, withdrawal and tapering followed by withdrawal were dominant in 39.8%, 28.2% and 29.0% of 10,000 iterations. Conclusion Our findings suggest that de-escalating bDMARDs in patients with RA may result in high cost savings but also a decrease in quality of life compared to standard care. If decision

The Aftermath of Tapering Tocilizumab After Achieving Treatment Target In Patients With Rheumatoid Arthritis: A Nationwide Cohort Study

“…We also showed that loss of CDAI-LDA at 1-year intervals was associated with higher HAQ-DI scores and poor disease control thereafter, which is in line with previous studies [30,31]. Although tapering TCZ dose may reduce direct medical costs, higher disease activity and impaired physical function would increase the indirect cost related to work disability [32,33]. Hence, our results suggest that the bene t of tapering TCZ dose does not overweigh the potential negative outcomes.…”

The Aftermath of Tapering Tocilizumab After Achieving Treatment Target in Patients With Rheumatoid Arthritis: A Nationwide Cohort Study

“…We also showed that loss of CDAI-LDA at 1-year intervals was associated with higher HAQ-DI scores and poor disease control thereafter, which is in line with previous studies ( 32 , 33 ). Although tapering TCZ dose may reduce direct medical costs, higher disease activity and impaired physical function would increase the indirect cost related to work disability ( 34 , 35 ). Hence, our results suggest that the benefit of tapering TCZ dose does not overweigh the potential negative outcomes.…”

Two-year cost effectiveness between two gradual tapering strategies in rheumatoid arthritis: cost-utility analysis of the TARA trial

“…Previous studies already showed that tapering biologicals leads to a reduction of medication and medical consumption costs, also known as direct costs, but could also result in a decrease in quality of life. [8][9][10][11] Tapering of medication might lead to an increase in disease activity and consequently to a disease flare. This could lead to more pain and disability, possibly resulting in more productivity loss and sick leave.…”