Cost per response for abatacept versus adalimumab in rheumatoid arthritis by ACPA subgroups in Germany, Italy, Spain, US and Canada
- PMID: 28560470
- PMCID: PMC5486786
- DOI: 10.1007/s00296-017-3739-9
Cost per response for abatacept versus adalimumab in rheumatoid arthritis by ACPA subgroups in Germany, Italy, Spain, US and Canada
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disorder leading to disability and reduced quality of life. Effective treatment with biologic DMARDs poses a significant economic burden. The Abatacept versus Adalimumab Comparison in Biologic-Naïve RA Subjects with Background Methotrexate (AMPLE) trial was a head-to-head, randomized study comparing abatacept in serum anti-citrullinated protein antibody (ACPA)-positive patients, with increasing efficacy across ACPA quartile levels. The aim of this study was to evaluate the cost per response accrued using abatacept versus adalimumab in ACPA-positive and ACPA-negative patients with RA from the health care perspective in Germany, Italy, Spain, the US and Canada. A cost-consequence analysis (CCA) was designed to compare the monthly costs per responding patient/patient in remission. Efficacy, safety and resource use inputs were based on the AMPLE trial. A one-way deterministic sensitivity analysis (OWSA) was also performed to assess the impact of model inputs on the results for total incremental costs. Cost per response in ACPA-positive patients favoured abatacept compared with adalimumab (ACR20, ACR90 and HAQ-DI). Subgroup analysis favoured abatacept with increasing stringency of response criteria and serum ACPA levels. Cost per remission (DAS28-CRP) favoured abatacept in ACPA-negative patients, while cost per CDAI and SDAI favoured abatacept in ACPA-positive patients. Abatacept was consistently favoured in ACPA-Q4 patients across all outcomes and countries. Cost savings were greater with abatacept when more stringent response criteria were applied and also with increasing ACPA levels, which could lead to a lower overall health care budget impact with abatacept compared with adalimumab.
Keywords: Biologic; Biomarker/prognostic factors; Cost-consequence analysis; Disease-modifying antirheumatic drugs; Incremental cost analysis; Rheumatoid arthritis.
Conflict of interest statement
Conflict of interest
Laure Weijers and Jason Foo have served as consultants to Bristol-Myers Squibb. Christoph Baerwald received honorarium for lectures and consultancies from Abbvie, Bristol-Myers Squibb, Chugai, Medac, MSD, Pfizer, and Roche. Dr. Martin Bergman has received consulting and speaking fees from Bristol-Myers Squibb, Abbvie, Celgene, Genentech, Amgen, Janssen, Pfizer and Novartis. He is a shareholder of Merck, Pfizer and JNJ. Chad Patel is an employee and shareholder of Bristol-Myers Squibb. Dr. Denis Choquette has received consulting and speaking fees from Bristol-Myers Squibb, Abbvie, Amgen, Celgene, Genentech, Amgen, Pfizer, Roche and Novartis.
Funding
This study was funded by Bristol-Myers Squibb.
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