Background Epidemiological studies have established that rheumatoid arthritis is associated with an increase in cardiovascular disease^1,2. The evaluation of tumour necrosis factor inhibitors (TNFi) on the reduction of the risk of acute myocardial infarction and death due to cardiovascular causes has shown promising results³. The economic evaluation for these outcomes are not established yet.

Objectives To evaluate the cost-effectiveness of TNFi versus disease-modifying antirheumatic drugs (Dmards) to avoid a new case of acute ischemic heart disease and death in rheumatoid arthritis patients.

Methods A cost-effectivenes analysis (CEA) was performed using a Markov model 6-month transition cycle, with time horizon of 30 years, under the Brazilian public healthcare system perspective. Costs are expressed in 2015 Reais and effectiveness measures are new cases of acute ischemic coronary disease and cardiovascular death.

Results The average cost in 30 years of Dmards and TNFi was 14,291,105.28 and 96,151,873.86 Reais, respectively. The incremental effectiveness was 2.69 cases of coronary artery disease and consequent incremental cost-effectiveness ratio (ICER) of 30,527,502.27 Reais per new cases avoided, while for cardiovascular death, incremental effectiveness was 1.33 and an ICER of 61,634,231,69 Reais per new cases avoided. The univariate analysis identified that the most relevant parameter in the ICER on both outcomes was the TNFi drug. The sensitivity analysis established that, in order to, reach the amount of willingness to pay (WTP) per semester to avoid an acute myocardial infarction, the average cost of TNFi should be 1,337.47 Reais per case avoided and the average cost for the cardiovascular death avoidence sould be 954.22 Reais. All the analyzes performed establish an unfavorable relationship of the drug treatment strategy with TNFi.

Conclusions The findings of the CEA among patients with rheumatoid arthritis for cardiovascular outcomes when compared to the strategy of TNFi drug treatment with the dominant strategy Dmards after the first 6 months of exposure point out an unfavorable relationship, surpassing the amount of expenses recommended by the Ministry of Health of Brazil in the year 2015.

References

1. Symmons DP, Gabriel SE. Epidemiology of CVD in rheumatic disease, with a focus on RA and SLE. Nat Rev Rheumatol. 2011;7(7):399–408.

2. Bergström U, Jacobsson LT, Turesson C. Cardiovascular morbidity and mortality remain similar in two cohorts of patients with long-standing rheumatoid arthritis seen in 1978 and 1995 in Malmö, Sweden. Rheumatology (Oxford). 2009;48(12):1600–5.

3. Dixon WG, Watson KD, Lunt M, Hyrich KL; British Society for Rheumatology Biologics Register Control Centre Consortium. Reduction in the incidence of myocardial infarction in patients with rheumatoid arthritis who respond to anti-tumor necrosis factor alpha therapy: results from the British Society for Rheumatology Biologics Register. Arthritis Rheum. 2007;56(9):2905–12.

References

Acknowledgements Foundation for Research Support of the State of São Paulo, FAPESP 2013/12979–1.

Disclosure of Interest None declared