RESEARCH - Cost-effectiveness of Orencia in patients with moderately to severely active RA and inadequate response to MTX

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Rheumatology 2008 47(4):535-541; doi:10.1093/rheumatology/ken007

Cost–effectiveness of abatacept in patients with moderately to

severely active rheumatoid arthritis and inadequate response to

methotrexate

M. Vera-Llonch1, E. Massarotti2, F. Wolfe3, N. Shadick4, R.

Westhovens5, O. Sofrygin1, R. Maclean6, Y. Yuan6 and G. Oster1

1Policy Analysis Inc. (PAI), Brookline, 2Tufts-New England Medical

Center, Boston, MA, 3National Data Bank for Rheumatic Diseases,

Wichita, KS, 4Brigham & Women's Hospital, Boston, MA, USA, 5University

Hospital, Katholieke Universiteit Leuven, Leuven, Belgium and

6Bristol-Myers Squibb, Princeton, NJ, USA.

Objective. To assess cost–effectiveness of abatacept in patients with

moderately to severely active RA and inadequate response to MTX.

Methods. We developed a simulation model to depict progression of

disability [in terms of the HAQ Disability Index (HAQ-DI)] in women

aged 55–64 yrs with moderately to severely active RA and inadequate

response to MTX. At model entry, patients were assumed to receive

either only MTX or MTX plus abatacept. Patients were then tracked from

model entry until death. Future health-state utilities and

medical-care costs (except study therapy) were estimated based on

predicted values of the HAQ-DI. The model was estimated using data

from a Phase III clinical trial of abatacept plus various secondary

sources. Cost–effectiveness was expressed in terms of incremental cost

(2006 US$) per quality-adjusted life-year (QALY) gained over

alternatively 10 yrs and a lifetime. Costs and health effects were

both discounted at 3% annually.

Results. Over 10 yrs, abatacept would yield 1.2 additional QALYs

(undiscounted) per patient (4.6 vs 3.4 for MTX) at an incremental

(discounted) cost of $51 426 ($103 601 vs $52 175, respectively); over

a lifetime, corresponding figures were 2.0 QALYS (6.8 vs 4.8) and $67

757 ($147 853 vs $80 096). Cost–effectiveness was [mean (95% CI)] $47

910 ($44 641, $52 136) per QALY gained over 10 yrs and $43 041 ($39

070, $46 725) per QALY gained over a lifetime. Findings were robust in

sensitivity analyses.

Conclusion. Abatacept is cost-effective by current standards of

medical practice in patients with moderately to severely active RA and

inadequate response to MTX.

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Read the entire article here:

http://rheumatology.oxfordjournals.org/cgi/content/full/47/4/535

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