Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2017 Jul;37(7):1111-1123.
doi: 10.1007/s00296-017-3739-9. Epub 2017 May 30.

Cost per response for abatacept versus adalimumab in rheumatoid arthritis by ACPA subgroups in Germany, Italy, Spain, US and Canada

Laure Weijers  1 , Christoph Baerwald  2 , Francesco S Mennini  3 , José M Rodríguez-Heredia  4 , Martin J Bergman  5 , Denis Choquette  6 , Kirsten H Herrmann  7 , Giulia Attinà  8 , Carmela Nappi  8 , Silvia Jimenez Merino  9 , Chad Patel  10 , Mondher Mtibaa  11 , Jason Foo  12
Affiliations
Randomized Controlled Trial

Cost per response for abatacept versus adalimumab in rheumatoid arthritis by ACPA subgroups in Germany, Italy, Spain, US and Canada

Laure Weijers et al. Rheumatol Int. 2017 Jul.

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.

PubMed Disclaimer

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.

Figures

Fig. 1
Fig. 1
Decision tree structure
Fig. 2
Fig. 2
Tornado diagrams depicting the impact of influential parameters on incremental costs for Germany, Italy, Spain, Canada and the US
Fig. 2
Fig. 2
Tornado diagrams depicting the impact of influential parameters on incremental costs for Germany, Italy, Spain, Canada and the US
Fig. 2
Fig. 2
Tornado diagrams depicting the impact of influential parameters on incremental costs for Germany, Italy, Spain, Canada and the US
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Lundkvist J, Kastang F, Kobelt G. The burden of rheumatoid arthritis and access to treatment: health burden and costs. Eur J Health Econ. 2008;8(Suppl 2):49–60. doi: 10.1007/s10198-007-0088-8. - DOI - PubMed
    1. Singh JA, Saag KG, Bridges SL, Jr, Akl EA, Bannuru RR, Sullivan MC, Vaysbrot E, McNaughton C, Osani M, Shmerling RH, Curtis JR, Furst DE, Parks D, Kavanaugh A, O’Dell J, King C, Leong A, Matteson EL, Schousboe JT, Drevlow B, Ginsberg S, Grober J, St Clair EW, Tindall E, Miller AS, McAlindon T. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol. 2016;68(1):1–26. doi: 10.1002/art.39480. - DOI - PubMed
    1. Smolen JS, Landewe R, Breedveld FC, Buch M, Burmester G, Dougados M, Emery P, Gaujoux-Viala C, Gossec L, Nam J, Ramiro S, Winthrop K, de Wit M, Aletaha D, Betteridge N, Bijlsma JW, Boers M, Buttgereit F, Combe B, Cutolo M, Damjanov N, Hazes JM, Kouloumas M, Kvien TK, Mariette X, Pavelka K, van Riel PL, Rubbert-Roth A, Scholte-Voshaar M, Scott DL, Sokka-Isler T, Wong JB, van der Heijde D. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis. 2014;73(3):492–509. doi: 10.1136/annrheumdis-2013-204573. - DOI - PMC - PubMed
    1. Gaultney J, Benucci M, Iannazzo S, Nappi C, Sion K, Sabater FJ. Trial-based cost-effectiveness of abatacept for rheumatoid arthritis patients in Italy. Expert Rev Pharmacoecon Outcomes Res. 2015;23:1–9. - PubMed
    1. Khanna D, Massarotti E, Rosenblatt L, Budd D, Sabater J, Hebden T (2013) Comparison of cost-efficacy of subcutaneous abatacept versus adalimumab in the treatment of patients with rheumatoid arthritis. Paper presented at the EULAR Annual Congress of Rheumatology, Madrid

Publication types

MeSH terms