Economic Evaluation of Sarilumab in the Treatment of Adult Patients with Moderately-to-Severely Active Rheumatoid Arthritis Who Have an Inadequate Response to Conventional Synthetic Disease-Modifying Antirheumatic Drugs.

Authors:
Noemi Muszbek
Noemi Muszbek
12 de Octubre Hospital
Spain
Clare Proudfoot
Clare Proudfoot
Formerly of Sanofi
Toronto | Canada
Andreas Kuznik
Andreas Kuznik
Infectious Diseases Institute
United States
Zsofia Kiss
Zsofia Kiss
University of California Davis
United States
Peter Gal
Peter Gal
Pavol Jozef Safárik University
Kaleb Michaud
Kaleb Michaud
University of Kansas School of Medicine
United States

Adv Ther 2019 Jun 19;36(6):1337-1357. Epub 2019 Apr 19.

University of Nebraska Medical Center, Omaha, NE, USA.

Introduction: Assess the cost-effectiveness (US healthcare payer perspective) of sarilumab subcutaneous (SC) 200 mg + methotrexate versus conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) or targeted DMARD + methotrexate for moderate-to-severe rheumatoid arthritis (RA) in adults with inadequate response to methotrexate.

Methods: Microsimulation based on patient profiles from MOBILITY (NCT01061736) was conducted via a 6-month decision tree and lifetime Markov model with 6-monthly cycles. Treatment response at 6 months was informed by a network meta-analysis and based on American College of Rheumatology (ACR) response. Responders: patients with ACR20 response who continued with therapy; non-responders: ACR20 non-responders who transitioned to the subsequent treatment. Utilities and quality-adjusted life-years (QALYs) were estimated via mapping 6-month ACR20/50/70 response to relative change in Health Assessment Questionnaire Disability Index score (short term) and based on published algorithms (long term). Direct costs considered drugs (wholesale acquisition costs), administration and routine care.

Results: Lifetime QALYs and costs for treatment sequences on the efficiency frontier were 3.43 and $115,019 for active csDMARD, 5.79 and $430,918 for sarilumab, and 5.94 and $524,832 for etanercept (all others dominated). Sarilumab was cost-effective versus tocilizumab and csDMARD (incremental cost-effectiveness ratios of $84,079/QALY and $134,286/QALY). Probabilistic sensitivity analysis suggested comparable costs and slightly improved health benefits for sarilumab versus tocilizumab, irrespective of threshold.

Conclusion: In patients with moderate-to-severe RA, sarilumab 200 mg SC every 2 weeks + methotrexate can be considered a cost-effective treatment option, with lower costs and greater health benefits than alternative treatment sequences (+ methotrexate) beginning with adalimumab, certolizumab, golimumab and tofacitinib and below commonly accepted cost-effectiveness thresholds against tocilizumab + methotrexate or csDMARD active treatment.

Funding: Sanofi and Regeneron Pharmaceuticals, Inc.

Download full-text PDF

Source
http://link.springer.com/10.1007/s12325-019-00946-1
Publisher Site
http://dx.doi.org/10.1007/s12325-019-00946-1DOI Listing
June 2019
10 Reads

Publication Analysis

Top Keywords

inadequate response
8
treatment sequences
8
conventional synthetic
8
synthetic disease-modifying
8
health benefits
8
versus tocilizumab
8
rheumatoid arthritis
8
sarilumab
6
response
6
treatment
6
costs
5
frontier 343
4
considered drugs
4
drugs wholesale
4
wholesale acquisition
4
csdmard 579
4
579 $430918
4
costs considered
4
algorithms long
4
long term
4

References

(Supplied by CrossRef)
Article in Arthritis Rheum
FC Arnett et al.
Arthritis Rheum 1988
Article in Curr Rheumatol Rep
E Myasoedova et al.
Curr Rheumatol Rep 2010
Article in MMWR Morb Mortal Wkly Rep
KE Barbour et al.
MMWR Morb Mortal Wkly Rep 2017
Article in Curr Med Res Opin
H Birnbaum et al.
Curr Med Res Opin 2010

A Shah et al.
2015
Article in J Rheumatol
A Beresniak et al.
J Rheumatol 2011
Article in Arthritis Res Ther.
M Grabner et al.
Arthritis Res Ther. 2017
Article in Ann Rheum Dis
JS Smolen et al.
Ann Rheum Dis 2016
Article in Arthritis Care Res (Hoboken).
JA Singh et al.
Arthritis Care Res (Hoboken). 2016
Article in Ann Rheum Dis
JS Smolen et al.
Ann Rheum Dis 2017
Article in Arthritis Rheumatol.
MC Genovese et al.
Arthritis Rheumatol. 2015

Similar Publications