RESEARCH - Cost-effectiveness modeling of biologic treatment sequences in moderate to severe RA in France

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Rheumatology Advance Access published online on January 16, 2010

Rheumatology, doi:10.1093/rheumatology/kep434

Cost-effectiveness modelling of biological treatment sequences in

moderate to severe rheumatoid arthritis in France

Alain Saraux1, Laure Gossec2, Philippe Goupille3, Bruno Bregman4,

Boccard5, le Dupont6 and Ariel Beresniak7,8

1Department of Rheumatology, Brest University, CHU Brest, Brest,

2Rheumatology B Department, Medicine Faculty, Paris Descartes

University, UPRES-EA, APHP, Cochin Hospital, Paris, 3Rheumatology

Department, Tours Hospital, François-Rabelais University, UMR CNRS,

Tours, 4Global Epidemiology and Outcomes Research, 5Bristol-Myers

Squibb, Rueil-Malmaison, France, 6Global Epidemiology and Outcomes

Research, Bristol-Myers Squibb International Corporation, Braine

L’Alleud, Belgium, 7LIRAES, Paris-Descartes University, Paris, France

and 8Data Mining International, Geneva, Switzerland.

Abstract

Objectives. Modern treatment of RA includes the use of biologics.

Their cost is high and comparison between different treatment

strategies is needed.

Method. Direct medical costs of RA in France were evaluated based on

expert opinion. Then, simulation–decision analytical models were

developed to assess four biologic treatment sequences over 2 years in

patients failing to respond to at least one anti-TNF agent.

Effectiveness was expressed in theoretical expected number of days

(TEND) in remission or low disease activity [low disease activity

score (LDAS)] based on DAS-28 scores.

Results. Direct medical costs of RA in France (excluding the cost of

biologics) were estimated at 905 (S.D. 263) for 6 months and 696 (S.D.

240) for each subsequent 6 months (P < 0.001) for patients achieving

LDAS and 1215 for 6 months (S.D. 405) for patients not achieving LDAS.

Based on LDAS criteria, using abatacept after an inadequate response

to the first anti-TNF agent (etanercept) appeared significantly (P <

0.01) more efficacious over a 2-year period (102 TEND) compared with

using rituximab at a 6-month re-treatment interval (82 TEND). Mean

cost-effectiveness ratios showed significantly lower costs (P < 0.01)

per TEND with abatacept as second biologic agent (278) compared with

rituximab (303). After an inadequate response to two anti-TNF agents,

using abatacept also appeared significantly more efficacious than an

anti-TNF agent (P < 0.01). All comparisons were confirmed when using

remission criteria instead of LDAS.

Conclusion. Advanced simulation models based on clinical evidence and

medical practice appear to be a promising approach for comparing

cost-effectiveness of biologic strategies in RA.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/kep434v1?papetoc

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