1. Economic Evaluation of Sequences of Biological Treatments for Patients With Moderate-to-Severe Rheumatoid Arthritis and Inadequate Response or Intolerance to Methotrexate in France
- Author
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Yves-Marie Pers, Salah Ghabri, Franck Maunoury, J. Jaime Caro, and Aymeric Binard
- Subjects
medicine.medical_specialty ,Total cost ,Cost-Benefit Analysis ,Severity of Illness Index ,Etanercept ,Arthritis, Rheumatoid ,03 medical and health sciences ,0302 clinical medicine ,Health care ,medicine ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Biosimilar Pharmaceuticals ,Cost–utility analysis ,business.industry ,030503 health policy & services ,Health Policy ,Public Health, Environmental and Occupational Health ,Biosimilar ,medicine.disease ,Clinical trial ,Methotrexate ,Models, Economic ,Rheumatoid arthritis ,Antirheumatic Agents ,Economic evaluation ,France ,Quality-Adjusted Life Years ,0305 other medical science ,business ,medicine.drug - Abstract
Objectives Biologic disease-modifying antirheumatic drugs (bDMARDs) are prescribed sequentially in the treatment of rheumatoid arthritis (RA). Healthcare decision makers continue to debate their use, mainly because of their high costs. Our aim was to perform an economic evaluation for France of bDMARD sequences for treatment of moderate-to-severe RA after inadequate response or intolerance to conventional DMARDs (eg, methotrexate). Methods A discretely integrated condition event simulation was developed to track the course of patients from first bDMARD through switches to further lines in a sequence. The model included 11 events, 91 conditions, and 21 controlling equations. Inputs were obtained from a meta-analysis of clinical trials, a French registry, national drug lists, and databases. Survival, time with minimal activity, quality-adjusted life-years (QALYs), and total costs were output. Structural and probabilistic sensitivity analyses were conducted. Results Sequences starting with etanercept biosimilars (ETB) cost less, with ETB–abatacept–infliximab the least expensive: the mean lifetime discounted total cost was €116 912 per patient, with a mean of 11.166 QALYs. Most other strategies were dominated or led to small QALY gains (0.0008-0.0329). Only ETB–tocilizumab–abatacept made it onto the efficiency frontier, but at €955 778 per QALY gained. These results were confirmed in several scenarios and uncertainty analyses. Conclusion Given minor differences in QALYs gained between bDMARD sequences with large cost differences, starting with biosimilars was more efficient than starting with branded products. Our model and findings should provide French and other decision makers with useful tools to address the challenges of comparing sequences of treatments for RA.
- Published
- 2019