A Cost-Effectiveness Analysis Of Abatacept, Tocilizumab, And Tnf-Inhibitor Compared With Rituximab As A Second-Line Therapy For Treatment Of Rheumatoid Arthritis

The purpose of this study was to evaluate the cost-effectiveness of abatacept, tocilizumab, and tumor necrosis factor (TNF) -inhibitors as compared with rituximab for the treatment of rheumatoid arthritis after the discontinuation of the first TNF-inhibitor treatment. A discrete event simulation model was designed to compare the cost-effectiveness of abatacept, rituximab, tocilizumab, and second TNF-inhibitor to one another. Baseline characteristics of the model population and all model assumptions were based on data from the National Register for Biologic Treatment in Finland (ROB-FIN). The model used lifetime horizon and the cycle length was set to six months. At the completion of each cycle, patients might continue the treatment, discontinue it or die. Quality-adjusted life years (QALY) were calculated from EQ-5D utilities mapped from the Health Assessment Questionnaire scores. The analysis was conducted from the societal perspective, and all costs were presented in 2016 euro. Direct costs comprised drug costs and use of health services, while indirect costs included early retirement due to rheumatoid arthritis and sick leave. Both the costs and QALYs were discounted at 3 % per year. Deterministic and probabilistic sensitivity analyses were conducted to explore the effect of different model values and assumptions on the result. As compared with rituximab, incremental direct costs of abatacept, tocilizumab, and TNF-inhibitor were 39,230 €, 28,340 €, and 25,870 €, respectively. Respective incremental costs including both direct and indirect costs were slightly higher. The number of QALYs gained were almost similar across all treatment regimens. Incremental cost-effectiveness ratios of abatacept, tocilizumab, and TNF-inhibitor as compared with rituximab were 656,320 €, 1,699,890 €, and 8,971,360 € per QALY, respectively. Owing to the similar effectiveness, but higher costs of abatacept, tocilizumab and TNF-inhibitor in comparison to rituximab, none of them were cost-effective at a willingness-to-pay threshold of 100,000€.