Background RA is a chronic, systemic inflammatory disorder often marked by joint damage, impaired function, pain, tenderness, increasing disability and reduced quality of life.1 Effective treatment of RA with biologic (b)DMARDs is a significant burden on European healthcare systems. Previous economic models comparing bDMARDs have often been based on database studies or indirect treatment comparisons. Robust, head-to-head, long-term outcomes studies are needed to evaluate the best choices for effective bDMARD treatment.
Objectives This analysis evaluated the economic value of SC abatacept relative to adalimumab, both in combination with MTX, in the treatment of RA. Direct medical costs associated with efficacy, tolerability and discontinuation were evaluated from an Italian national healthcare perspective.
Methods A previously published decision tree model based on 1-year data from AMPLE2,3 was adapted for patients with RA for whom 2 years of data were available in an Italian setting. Outcomes and events of interest were abstracted directly from the AMPLE study after 2 years. Unit costs were estimated from published public prices, and cost estimates evaluated from a public payer perspective over a 2-year time horizon using € 2014. Cost-consequence analysis (CCA) was used for comparisons. One-way sensitivity analyses were used to assess the uncertainty of key model inputs. Efficacy was evaluated using ACR20, 50, 70, 90 and HAQ-DI endpoints. Safety and tolerability endpoints included serious adverse events (AEs), injection-site reactions, malignancies and discontinuation reported in AMPLE.
Results Cost analyses favoured abatacept over adalimumab across the cohort of 1000 patients. Direct treatment costs with abatacept were € 378,997 lower over 2 years compared to those for similarly dosed adalimumab patients. Abatacept had lower costs associated with treatment-related serious AEs (€ 176,856 vs € 298,620). Patients had similar outcomes on the two treatments, and thus CCA of efficacy demonstrated that, for efficacy outcomes favouring abatacept (ACR70, 90, HAQ-DI), the incremental costs were negative (i.e. cost savings were achieved with superior health outcomes), ranging from € 5678 to € 21,040 per incremental patient achieving target in favour of abatacept. For the efficacy outcomes that were in favour of adalimumab (ACR20, ACR50), gains were associated with higher costs. Additional costs ranged from € 13,248 to € 89,422 per incremental patient achieving target in favour of adalimumab. Abatacept demonstrated a cost saving per discontinuation avoided of € 7944. Findings were robust under one-way sensitivity analysis.
Conclusions The health economic value of abatacept compared with adalimumab from the perspective of the Italian NHS depends on the choice of health outcome endpoint. For health outcomes favouring abatacept, cost savings are realized. Health outcomes with abatacept reduce the overall budget impact. For adalimumab, the health gains require additional costs. These improvements in health outcomes lead to an increase in the budget impact.
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Disclosure of Interest J. Gaultney: None declared, D. Budd Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, C. Nappi Employee of: Bristol-Myers Squibb, M. Benucci: None declared, S. Iannazzo Consultant for: MAPI Values, E. Alemao Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, J. Sabater Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb