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Randomized Controlled Trial
. 2022 Nov 16;20(1):97.
doi: 10.1186/s12969-022-00748-w.

Economic evaluation of infliximab, synthetic triple therapy and methotrexate in the treatment of newly diagnosed juvenile idiopathic arthritis

Maarit Tarkiainen  1   2   3 , Pirjo Tynjälä  4   5 , Paula Vähäsalo  6   7 , Kristiina Aalto  8   4   5 , Liisa Kröger  9 , Katariina Rebane  8   4   5 , Pekka Lahdenne  8   4   5 , Janne Martikainen  10
Affiliations
Randomized Controlled Trial

Economic evaluation of infliximab, synthetic triple therapy and methotrexate in the treatment of newly diagnosed juvenile idiopathic arthritis

Maarit Tarkiainen et al. Pediatr Rheumatol Online J. .

Abstract

Background: Evaluation of costs and short-term cost-effectiveness of infliximab plus methotrexate (IFX + MTX); triple therapy of hydroxychloquine, sulphasalazine, and methotrexate (TRIPLE); or methotrexate monotherapy (MTX) in patients with new-onset polyarticular juvenile idiopathic arthritis (JIA).

Methods: In a prospective multicenter study (ACUTE-JIA), costs and health outcomes of 60 randomized patients with new-onset disease-modifying anti-rheumatic drug (DMARD)-naïve polyarticular JIA were analyzed during the first year. A mapping algorithm was used to obtain utility values from Child Health Assessment Questionnaire (CHAQ). Wallace criteriae were used to assess clinically inactive disease (CID). Linear regression with non-parametric bootstrapping was used to adjust imbalances at baseline.

Results: Using prices for IFX biosimilar, adjusted annual mean (SD) costs of treatment (€) were 21,164 (4158), 12,136 (5286), and 18,300 (8635) on IFX + MTX, TRIPLE, and MTX, respectively. Incremental cost-effectiveness ratio (ICER) for IFX + MTX as compared with TRIPLE or MTX were 3442 € or 678 € per additional month spent in CID. Mean (SD) quality-adjusted life years (QALYs) for IFX + MTX, TRIPLE and MTX were 0.755 (0.065), 0.725 (0.062), and 0.686 (0.124). ICER for IFX + MTX vs TRIPLE was 294,433 €, and for IFX + MTX vs MTX 31,435 € per QALY gained.

Conclusions: In short-term, biosimilar IFX + MTX can be considered cost-effective when compared with MTX alone. TRIPLE was cost-effective when compared with MTX and showed cost advantage when compared with IFX + MTX. Cost per time spent in CID showed similar results than ICER evaluations.

Trial registration: This trial was primarily registered with the Ethical Board of Helsinki District University Hospital ( https://www.hus.fi ), clinical trial number 211864, and later with ClinicalTrials.gov, number NCT01015547.

Keywords: Biological therapy; Disease-modifying anti-rheumatic drugs; health economic evaluation; Juvenile idiopathic arthritis.

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Conflict of interest statement

PV reports non-financial support from Abbvie, and Novartis; personal fees and non-financial support from Pfizer, MSD, Sobi, and Roche, outside the submitted work; JM is a founding partner of ESiOR Oy and a board member of Siltana Oy. These companies were not involved in carrying out this research. Other authors have nothing to declare.

Figures

Fig. 1
Fig. 1
(A) Cost-effectiveness acceptability frontier (based on 1000 bootstrap iterations) indicating the probability of the optimal treatment option being cost-effective across different willingness-to-pay (WTP) thresholds per month in clinically inactive disease (CID) and (B) per quality-adjusted life-year (QALY) gained. C Incremental cost-effectiveness ratio (ICER) of infliximab plus methotrexate (IFX) vs. TRIPLE (methotrexate, hydroxychloroquine, and sulphasalazine) as function of infliximab price. D ICER of infliximab plus methotrexate (IFX) vs. methotrexate monotherapy (MTX)
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