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Comparative Study
. 2019 Jun;36(6):1337-1357.
doi: 10.1007/s12325-019-00946-1. Epub 2019 Apr 19.

Economic Evaluation of Sarilumab in the Treatment of Adult Patients with Moderately-to-Severely Active Rheumatoid Arthritis Who Have an Inadequate Response to Conventional Synthetic Disease-Modifying Antirheumatic Drugs

Noemi Muszbek  1 , Clare Proudfoot  2 , Marie Fournier  3 , Chieh-I Chen  4 , Andreas Kuznik  4 , Zsofia Kiss  5 , Peter Gal  6 , Kaleb Michaud  7   8
Affiliations
Comparative Study

Economic Evaluation of Sarilumab in the Treatment of Adult Patients with Moderately-to-Severely Active Rheumatoid Arthritis Who Have an Inadequate Response to Conventional Synthetic Disease-Modifying Antirheumatic Drugs

Noemi Muszbek et al. Adv Ther. 2019 Jun.

Abstract

Introduction: Assess the cost-effectiveness (US healthcare payer perspective) of sarilumab subcutaneous (SC) 200 mg + methotrexate versus conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) or targeted DMARD + methotrexate for moderate-to-severe rheumatoid arthritis (RA) in adults with inadequate response to methotrexate.

Methods: Microsimulation based on patient profiles from MOBILITY (NCT01061736) was conducted via a 6-month decision tree and lifetime Markov model with 6-monthly cycles. Treatment response at 6 months was informed by a network meta-analysis and based on American College of Rheumatology (ACR) response. Responders: patients with ACR20 response who continued with therapy; non-responders: ACR20 non-responders who transitioned to the subsequent treatment. Utilities and quality-adjusted life-years (QALYs) were estimated via mapping 6-month ACR20/50/70 response to relative change in Health Assessment Questionnaire Disability Index score (short term) and based on published algorithms (long term). Direct costs considered drugs (wholesale acquisition costs), administration and routine care.

Results: Lifetime QALYs and costs for treatment sequences on the efficiency frontier were 3.43 and $115,019 for active csDMARD, 5.79 and $430,918 for sarilumab, and 5.94 and $524,832 for etanercept (all others dominated). Sarilumab was cost-effective versus tocilizumab and csDMARD (incremental cost-effectiveness ratios of $84,079/QALY and $134,286/QALY). Probabilistic sensitivity analysis suggested comparable costs and slightly improved health benefits for sarilumab versus tocilizumab, irrespective of threshold.

Conclusion: In patients with moderate-to-severe RA, sarilumab 200 mg SC every 2 weeks + methotrexate can be considered a cost-effective treatment option, with lower costs and greater health benefits than alternative treatment sequences (+ methotrexate) beginning with adalimumab, certolizumab, golimumab and tofacitinib and below commonly accepted cost-effectiveness thresholds against tocilizumab + methotrexate or csDMARD active treatment.

Funding: Sanofi and Regeneron Pharmaceuticals, Inc.

Keywords: Cost effectiveness; Disease-modifying anti-rheumatic; IL-6; Rheumatoid arthritis; Sarilumab.

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Figures

Fig. 1
Fig. 1
Model flow. csDMARD conventional synthetic disease-modifying antirheumatic drug; csDMARD-IR inappropriate response or intolerance to csDMARDs/methotrexate; HAQ-DI Health Assessment Questionnaire Disability Index; QALYs quality-adjusted life-years. Comparators: sarilumab SC 200 mg or placebo SC q2w + methotrexate; adalimumab 40 mg SC q2w + methotrexate; certolizumab 200 mg SC q2w + methotrexate; etanercept 25 mg SC q1w + methotrexate; golimumab 50 mg SC q4w + methotrexate; tocilizumab 162 mg SC q1w or q2w + methotrexate; tofacitinib 5 mg twice daily oral + methotrexate; csDMARD active treatment
Fig. 2
Fig. 2
Deterministic and probability sensitivity analyses: a cost-effectiveness efficiency frontier with and without csDMARD active treatment; b tornado diagram of incremental net benefit vs. TCZ; c cost-effectiveness plane for sarilumab 200 mg SC q2w + methotrexate vs. tocilizumab 162 mg SC q1w/q2w mix + methotrexate; d cost-effectiveness acceptability curve. ADA adalimumab; CTZ certolizumab; ETA etanercept; GOL golimumab; INB incremental net benefit; MTX methotrexate; SAR sarilumab; SC subcutaneous; TCZ tocilizumab; TOF tofacitinib
Fig. 2
Fig. 2
Deterministic and probability sensitivity analyses: a cost-effectiveness efficiency frontier with and without csDMARD active treatment; b tornado diagram of incremental net benefit vs. TCZ; c cost-effectiveness plane for sarilumab 200 mg SC q2w + methotrexate vs. tocilizumab 162 mg SC q1w/q2w mix + methotrexate; d cost-effectiveness acceptability curve. ADA adalimumab; CTZ certolizumab; ETA etanercept; GOL golimumab; INB incremental net benefit; MTX methotrexate; SAR sarilumab; SC subcutaneous; TCZ tocilizumab; TOF tofacitinib
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References

    1. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988;31:315–324. doi: 10.1002/art.1780310302. - DOI - PubMed
    1. Myasoedova E, Davis JM, 3rd, Crowson CS, et al. Epidemiology of rheumatoid arthritis: rheumatoid arthritis and mortality. Curr Rheumatol Rep. 2010;12:379–385. doi: 10.1007/s11926-010-0117-y. - DOI - PubMed
    1. Barbour KE, Helmick CG, Boring M, et al. Vital signs: prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation—United States, 2013–2015. MMWR Morb Mortal Wkly Rep. 2017;66:246–253. doi: 10.15585/mmwr.mm6609e1. - DOI - PMC - PubMed
    1. Birnbaum H, Pike C, Kaufman R, et al. Societal cost of rheumatoid arthritis patients in the US. Curr Med Res Opin. 2010;26:77–90. doi: 10.1185/03007990903422307. - DOI - PubMed
    1. Shah A, St Clair W, et al. Rheumatoid arthritis. In: Kasper D, Fauci A, Hauser S, et al., editors. Harrison’s principles of internal medicine. 19. New York: McGraw-Hill Education; 2015.

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