The Cost-Effectiveness of Tocilizumab (Actemra) Therapy in Giant Cell Arteritis

Abstract

Background: Tocilizumab (Actemra) is a humanized antiinterleukin-6 receptor antibody that has been used as a steroid-sparing agent in giant cell arteritis (GCA). Although the clinical effects are well described in GCA, the costeffectiveness of the use of tocilizumab in GCA is ill defined. The purpose of this study was to determine the cost-effectiveness of tocilizumab in GCA compared with prednisone alone. Methods: A retrospective study of 32 patients with biopsyproven GCA comparing prednisone alone (16 patients) and prednisone with tocilizumab (16 patients) was performed. The cost for tocilizumab therapy for 26 weeks with mild and severe side effects (Groups 1 and 2, respectively) and for 52 weeks with mild and severe side effects (Group 3 and 4, respectively) was compared with estimated costs of mild and severe steroid-induced side effects (Groups 5 and 6, respectively). Statistical analysis between groups was conducted using independent sample t tests. Results: Three out of the 4 group combinations of tocilizumab with prednisone demonstrated a statistically significant (P , 0.05) difference in cost compared with prednisone alone for GCA. Group 2 (26-week tocilizumab therapy with severe steroid-induced side effects), with no statically significant difference in price when compared with steroid therapy alone and far fewer side effects, demonstrated the potential use of tocilizumab in GCA therapy. As expected, longer treatment duration with tocilizumab was associated with greater cost. With respect to side effect severity, the number of side effects of steroid therapy was inversely associated with difference in cost between tocilizumab therapy and steroid side effect treatment. Conclusion:This study demonstrates that combination therapy of tocilizumab and prednisone is significantly more expensive than steroids alone with or without accounting for the cost of steroid-induced side effects in treated GCA. The difference in cost between the 2 therapy types is directly related to tocilizumab therapy duration and inversely related to the number or severity of steroid side effects. Patients with GCA who require a shorter duration of steroid therapy and are at risk for a high number of side effects from steroid use may be potential candidates for tocilizumab therapy, from an economic perspective.

Circulating PD-1hiCXCR5- and CXCR5+ CD4 T cells are elevated in patients with newly diagnosed Giant Cell Arteritis and predict relapse

“…In the present study, our patients received treatment according to the current EULAR recommendations [18]. These are based on the observation that a significant proportion of patients with GCA receiving GC monotherapy do not relapse and are able to reduce the GC dose down to ≤5 mg/day after 1 year [18,46–48]; hence, the prompt initiation of DMARDs in steroid-responsive subjects would unnecessarily promote safety hazards [18] and increase costs [18,49]. Our results on the predictive value of cTph and cTfh cells may help identify patients with an increased risk of relapse who would benefit from an early treatment intensification and/or addition of DMARDs.…”

“…[18] and increase costs [18,49]. Our results on the predictive value of cTph and cTfh cells may help identify patients with an increased risk of relapse who would benefit from an early treatment intensification and/or addition of DMARDs.…”

The Meteoritics Trial: efficacy of methotrexate after remission-induction with tocilizumab and glucocorticoids in giant cell arteritis—study protocol for a randomized, double-blind, placebo-controlled, parallel-group phase II study

“…The primary risk of treatment with TCZ is the increased risk of infections [ 14 , 17 , 18 ]. Moreover, TCZ therapy is significantly more expensive than GC therapy alone and results in C-reactive protein (CRP) not being used as an acute inflammatory marker in clinical practice [ 19 , 20 ]. The optimal duration of TCZ treatment for patients in a stable remission without GC remains uncertain, as does the appropriate strategy following treatment discontinuation to minimize relapse rates.…”

The Meteoritics Trial: Efficacy of Methotrexate after Remission-Induction with Tocilizumab and Glucocorticoids in Giant Cell Arteritis: Study Protocol for a Randomized, Double-Blind, Placebo-Controlled, Parallel Group Phase II Study

“…The main risk of treatment with TCZ is the increased risk of infections (14,17,18). Moreover, TCZ therapy is signi cantly more expensive than GC therapy alone and results in C-reactive protein (CRP) not being used as an acute in ammatory marker in clinical practice (19,20). The optimal duration of TCZ treatment for patients in a stable GC-free remission remains uncertain, as does the appropriate strategy following treatment discontinuation to minimize relapse rates.…”