PMS40 Economic Evaluation of Etanercept in Rheumatoid Arthritis from the Public Payer perspective in Brazil

Abstract

simulate RA evolution after treatment with etanercept (basecase treatment), adalimumab or infliximab as first-line therapies and their associated costs over a 12-month time horizon. Therapy continuation or switch was evaluated at week 24. Effectiveness measures were ACR70 response and quality adjusted life years (QALYs) gained. Direct medical costs included biologics, concomitant drugs, medical follow-up and adverse events management. Clinical response was extracted from published literature, while costs were collected from Colombian public official databases. Probabilistic sensitivity analyses were performed through Monte Carlo Simulation second-order approach. RESULTS: In base case analysis estimated effectiveness resulted in [ACR70, QALY]: etanercept [31.3%, 0.79]; adalimumab [18.1%, 0.77] and infliximab [12.8%, 0.73]. Expected mean costs per patient were 23,065USD, 24,869USD and 25,853USD, respectively. In cost-effectiveness and cost-utility analysis, etanercept was the less costly and the most effective alternative being cost-saving in all comparisons: 2789USD less than infliximab(most costly alternative); 18.5% more patients met ACR70 response regarding infliximab(the least effective alternatives); incremental utility reached -0.0576 versus infliximab. Acceptability curves showed that etanercept regardless willingness to pay would be the most cost-effective biologic. CONCLUSIONS: Due to its lower costs and favorable effectiveness profile, etanercept is dominant regarding ACR70 response and QALYs gained over other biologic treatments in the management of RA at Colombian public health care system. OBJECTIVES:Oral glucosamine formulations are frequently used as a food supplement for joint maintenance, with little supportive evidence. However, Glusartel, a formulation of glucosamine (produced by Rottapharm), has been shown to increase oral bioavailability and has been studied in over 7,000 patients, showing a significant improvement in joint space narrowing and knee replacement. The costeffectiveness of the new product was studied compared to both standard of care and other glucosamine products. METHODS: A four state (with death as a sink state) Markov model was constructed to investigate disease progression, patient utility (mapped from the Western Ontario and McMaster Universities Arthritis Index (WOMAC)) and cost. Efficacy was taken from two pivotal trials, while costs were taken from standard sources including NHS Reference Costs, PSSRU, and the British National Formulary. All costs were inflated to financial year 2009/2010, with the perspective taken that of NHS Scotland. RESULTS: Using a 50 year (lifetime) time horizon, with patients beginning treatment at age 62 (as seen in the clinical trials), patients treated with Glusartel are estimated to cost £1799 more than those treated with standard management (£6443 vs. £4645), but gain an additional 0.15 (2 d.p.) QALYs (9.45 vs. 9.31), generating an ICER of £12,402. Compared with currently used glucosamine treatment, even conservatively assuming equal efficacy...