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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.

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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

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