Background 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-Naive RA Subjects with Background Methotrexate (AMPLE) trial was a head-to-head, randomized study comparing SC abatacept with SC adalimumab.1 Recent subgroup analyses showed improved efficacy for abatacept in serum anti-citrullinated protein antibody (ACPA)-positive patients, with increasing efficacy across ACPA quartile levels.2
Objectives To evaluate the cost per response of abatacept relative to adalimumab in ACPA-positive patients with RA from the Italian, Spanish and Canadian societal perspectives.
Methods A decision tree was designed to compare the cost per response of abatacept with adalimumab in a cohort of 1000 ACPA-positive patients (Q1: 28–235 AU/mL, Q2: 236–609 AU/mL, Q3: 613–1046 AU/mL, Q4: 1060–4894 AU/mL) over 2 years. Clinical inputs were based on the AMPLE trial, and response was based on ACR20/50/70/90 and HAQ-DI. Unit costs for direct medical costs of AEs were based on local tariffs for disease-related groups and the ex-manufacturer's price, including mandatory reductions, payback and transparent discounts for drugs. Societal costs included patient costs, indirect costs of work absence and early retirement, according to HAQ functional capacity categories.
Results The cost per response in ACPA-positive patients favoured SC abatacept compared with SC adalimumab for ACR20, ACR70, ACR90 and HAQ-DI across all countries (Table 1). When evaluating across ACPA quartiles, cost per ACR20, ACR50 and ACR70 favoured SC abatacept with increasing stringency of response criteria and serum ACPA levels. Cost per ACR90 and HAQ-DI response consistently favoured SC abatacept across all ACPA subgroups and countries. In terms of cost per remission across all countries, cost per DAS28 favoured SC abatacept in ACPA-negative patients, while cost per CDAI and SDAI favoured SC abatacept in ACPA-positive patients.SC abatacept was consistently favoured in ACPA-Q4 patients across all outcomes and countries.
Conclusions The costs per responder were lower for SC abatacept than SC adalimumab in ACPA-Q4 patients across all countries. Cost savings were greater when more stringent response criteria were applied and also with increasing ACPA levels, which could lead to a lower overall healthcare budget impact with abatacept compared with adalimumab in Italy, Spain and Canada.
Schiff M, et al. Ann Rheum Dis 2014;73:86–94.
Sokolove J, et al. Ann Rheum Dis. 2015 Sep 10. doi: 10.1136/annrheumdis-2015-207942.
Disclosure of Interest J. Foo Consultant for: Bristol-Myers Squibb, F. Mennini: None declared, J. M. Rodriguez Heredia: None declared, D. Choquette Consultant for: Amgen, AbbVie, Bristol-Myers Squibb, Celgene, Pfizer, Merck, Janssen, Roche, G. Attina Employee of: Bristol-Myers Squibb, S. Jiménez Merino Employee of: Bristol-Myers Squibb, M. Mtibaa Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, E. Alemao Shareholder of: Bristol-Myers Squibb, Employee of: Bristol-Myers Squibb, J. Gaultney Consultant for: Bristol-Myers Squibb