Background Cost-effectiveness studies provide valuable information on the costs and benefits of the treatments. This information is needed to guide the optimal utilization of limited healthcare resources. Biological drugs for Rheumatoid arthritis (RA) are expensive, yet have great potential to improve patients' quality of life. Therefore they are an important target for economic evaluation.
Objectives The aim of this systematic review is to identify existing studies examining the cost-effectiveness of biologics for RA, assess their quality and report their results systematically.
Methods The literature search covering Medline, Scopus, Cochrane library, ACP Journal club and Web of Science was performed in March 2013. The cost-utility analyses of one or more available biological drugs for the treatment of RA in adults were included in the current review. The information on patients, treatments, study design and outcomes were collected using a standardized data collection form. The quality of the studies was assessed using previously published checklists. The results of included studies were stratified by the patients' previous treatments.
Results Of the 4890 references found in the literature search, 38 cost-utility analyses were included in the current systematic review. Thirty-four of the included studies used a modelling approach, while remaining four were empiric studies. The incremental cost-effectiveness ratio (ICER) of the tumor necrosis factor (TNF) blockers ranged from 13,500 to 772,000 €/quality adjusted life year (QALY) in comparison to conventional disease modifying anti rheumatic drugs (cDMARD) in patients with no previous treatment with cDMARDs. Among patients with an insufficient response to cDMARDs, TNF blockers were associated with ICERs ranging from 6,700 to 317,000 €/QALY. Rituximab was found to be the most cost-effective alternative in contrast to other biologics among the patients with an insufficient response to TNF blockers.
Conclusions Considering 50,000 €/QALY as an acceptable threshold for the ICER, TNF blockers are unlikely to be cost-effective among patients naïve to cDMARDs. Meanwhile, among patients with an insufficient response to cDMARDs they might be cost-effective. Heterogeneity in study designs was reflected in the results and made the comparison of studies difficult. The quality assessment revealed various types of biases in the included studies, potentially compromising the validity of their results.
Disclosure of Interest None declared
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