Remicade: a pharmacoeconomic review of its use in RA

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Pharmacoeconomics. 2004;22(2):107-32.

Infliximab: a pharmacoeconomic review of its use in rheumatoid

arthritis.

Lyseng-on KA, RH.

Adis International Limited, Auckland, New Zealand. demail@...

Infliximab (Remicade), a biological disease-modifying antirheumatic drug

(DMARD), binds to and inhibits the activity of tumour necrosis

factor-alpha, which is thought to play an important role in the

pathophysiology of rheumatoid arthritis. Intravenous infliximab plus

methotrexate is recommended in patients with rheumatoid arthritis who

have not achieved satisfactory disease control with adequate courses of

other DMARDs. Pharmacoeconomic analyses have been based on efficacy data

from the pivotal placebo-controlled Anti-Tumour Necrosis Factor Trial in

Rheumatoid Arthritis with Concomitant Therapy (ATTRACT) trial in

patients with active, refractory rheumatoid arthritis. Infliximab every

8 weeks plus methotrexate demonstrated rapid and sustainable

improvements in clinical response, delayed radiographic progression,

and/or improved functional status and health-related QOL compared with

placebo plus methotrexate at weeks 30, 54 and 102. In cost-utility

analyses of infliximab plus methotrexate conducted from a healthcare

payer and/or societal perspective in the US, Europe, Portugal, Sweden

and the UK, infliximab 3 mg/kg every 8 weeks plus methotrexate was

associated with acceptable (<$US50,000 per discounted QALY gained)

cost-utility ratios relative to methotrexate alone in patients with

active, refractory rheumatoid arthritis. When only direct costs were

considered, the lifetime incremental cost per discounted QALY gained

with infliximab plus methotrexate relative to methotrexate alone was

$US30,500-38,700 (year of costing 1998 or not reported; treatment

duration 54 or 102 weeks or lifelong) in the US and Europe analyses, and

euro39 500 (year of costing not reported; lifelong treatment) in the

Portuguese analysis. The cost-utility ratios were more favourable when

lost productivity costs or the additional benefit of infliximab on

radiographic stabilisation were considered. In the Swedish and UK

analyses with a 10-year time horizon, infliximab plus methotrexate for 1

or 2 years was associated with cost-utility ratios of euro28 600-56 100

(year of costing not reported) when direct costs were considered, and

euro3440-48 200 when direct costs plus loss-of-productivity costs were

considered.

In conclusion, cost-utility analyses, which were based on

modelling of data from the pivotal clinical trial of infliximab plus

methotrexate, indicate that infliximab plus methotrexate is associated

with acceptable cost-effectiveness ratios (<$US50,000 per discounted

QALY gained) relative to methotrexate monotherapy in patients with

active rheumatoid arthritis who have not responded to previous

methotrexate or other DMARD therapy. The cost effectiveness of

infliximab versus other DMARDs is at present unclear, but will be

clarified when appropriate data from directly comparative clinical

and/or pharmacoeconomic studies become available. In patients in whom

adequate courses of other DMARDs have failed to achieve satisfactory

disease control, infliximab plus methotrexate may prevent or delay

disability, which may produce reductions in nondrug costs that can help

offset its acquisition cost.

PMID: 14731052

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