Cost-effectiveness analyses of biologic and targeted synthetic disease-modifying anti-rheumatic diseases in patients with rheumatoid arthritis: Three approaches with a cohort simulation and real-world data

Abstract

Objective To assess cost-effectiveness of biologic and targeted synthetic disease-modifying anti-rheumatic drugs (b/tsDMARDs) in rheumatoid arthritis. Methods We conducted 3 analyses: a lifetime analysis with a cohort model (study A) and 2 short-term analyses (studies B and C). Study A evaluated the incremental cost-effectiveness ratio (ICER) per quality-adjusted life-year (QALY) gained from costs of standard treatments. Study B evaluated yearly costs per person achieving American College of Rheumatology (ACR) response (ACR20, ACR50, and ACR70), and study C, costs per person achieving previously defined claims-based effectiveness (equivalent to 28-joint Disease Activity Score [DAS28] ≤ 3.2). The proportion of ACR responders to the drugs of interest were determined by mixed treatment comparisons. Studies B and C estimated costs using a claims database. Results In study A, ICERs of all b/tsDMARDs were lower than 5.0 million JPY per QALY. In study B, yearly costs per person with ACR50 response were lower for subcutaneous tocilizumab (1.9 million JPY) and subcutaneous abatacept (2.3 million JPY). In study C, costs per person were lower for subcutaneous tocilizumab (1.3 million JPY) and intravenous tocilizumab (1.6 million JPY) and effectiveness rates were higher for intravenous tocilizumab (45.3%) and infliximab (43.0%). Conclusion The b/tsDMARDs with lower prices showed higher cost-effectiveness.

Cost-effectiveness of janus kinase inhibitors for rheumatoid arthritis: A systematic review and meta-analysis of cost-utility studies

“…We included seventeen ( Lee et al, 2015 ; Jansen et al, 2017 ; Claxton et al, 2018 ; Chen et al, 2019 ; Fournier et al, 2019 ; Muszbek et al, 2019 ; Schlueter et al, 2019 ; Navarro et al, 2020 ; Tian et al, 2020 ; Van De Laar et al, 2020 ; Li et al, 2021a ; Li et al, 2021b ; Fatemi et al, 2021 ; Ha et al, 2021 ; Tan et al, 2021 ; Kuwana et al, 2022 ; Tan et al, 2022 ) relevant studies for systematic review, of which fifteen studies ( Lee et al, 2015 ; Jansen et al, 2017 ; Claxton et al, 2018 ; Chen et al, 2019 ; Muszbek et al, 2019 ; Schlueter et al, 2019 ; Navarro et al, 2020 ; Tian et al, 2020 ; Van De Laar et al, 2020 ; Li et al, 2021a ; Fatemi et al, 2021 ; Ha et al, 2021 ; Tan et al, 2021 ; Kuwana et al, 2022 ; Tan et al, 2022 ) were eligible for meta-analysis ( Figure 1 ). All the studies with JAK-i as an intervention were included for the meta-analysis ( n = 15), whereas studies that compared JAK-i versus JAK-i ( n = 2) were included for systematic review only ( Fournier et al, 2019 ; Li et al, 2021b ).…”

“…Thirteen studies ( Lee et al, 2015 ; Claxton et al, 2018 ; Chen et al, 2019 ; Muszbek et al, 2019 ; Schlueter et al, 2019 ; Navarro et al, 2020 ; Tian et al, 2020 ; Van De Laar et al, 2020 ; Li et al, 2021a ; Fatemi et al, 2021 ; Ha et al, 2021 ; Tan et al, 2021 ; Kuwana et al, 2022 ) assessed the cost-effectiveness of JAK-i as second line treatment in RA patients who showed an inadequate response to csDMARDs. Five studies ( Jansen et al, 2017 ; Claxton et al, 2018 ; Navarro et al, 2020 ; Tan et al, 2021 ; Tan et al, 2022 ) assessed the cost-effectiveness of JAK-i compared to csDMARD/bDMARDs as the third-line treatment for RA patients who showed an inadequate response to TNF-a-i following csDMARD failure.…”

“…Eleven studies ( Lee et al, 2015 ; Jansen et al, 2017 ; Claxton et al, 2018 ; Chen et al, 2019 ; Fournier et al, 2019 ; Muszbek et al, 2019 ; Schlueter et al, 2019 ; Navarro et al, 2020 ; Van De Laar et al, 2020 ; Ha et al, 2021 ; Kuwana et al, 2022 ) were from High-income countries (HIC), five studies from upper-middle-income countries (UMICs) ( Tian et al, 2020 ; Li et al, 2021a ; Li et al, 2021b ; Tan et al, 2021 ; Tan et al, 2022 ) and only one study from lower middle-income country (LMICs). ( Fatemi et al, 2021 ) ICER was calculated from a Health system perspective in eleven studies, ( Claxton et al, 2018 ; Fournier et al, 2019 ; Muszbek et al, 2019 ; Schlueter et al, 2019 ; Navarro et al, 2020 ; Tian et al, 2020 ; Li et al, 2021a ; Li et al, 2021b ; Tan et al, 2021 ; Kuwana et al, 2022 ; Tan et al, 2022 ) societal perspective in four studies, ( Lee et al, 2015 ; Jansen et al, 2017 ; Van De Laar et al, 2020 ; Ha et al, 2021 ) and payer’s perspective in two studies.…”

“…Eleven studies ( Lee et al, 2015 ; Jansen et al, 2017 ; Claxton et al, 2018 ; Chen et al, 2019 ; Fournier et al, 2019 ; Muszbek et al, 2019 ; Schlueter et al, 2019 ; Navarro et al, 2020 ; Van De Laar et al, 2020 ; Ha et al, 2021 ; Kuwana et al, 2022 ) were from High-income countries (HIC), five studies from upper-middle-income countries (UMICs) ( Tian et al, 2020 ; Li et al, 2021a ; Li et al, 2021b ; Tan et al, 2021 ; Tan et al, 2022 ) and only one study from lower middle-income country (LMICs). ( Fatemi et al, 2021 ) ICER was calculated from a Health system perspective in eleven studies, ( Claxton et al, 2018 ; Fournier et al, 2019 ; Muszbek et al, 2019 ; Schlueter et al, 2019 ; Navarro et al, 2020 ; Tian et al, 2020 ; Li et al, 2021a ; Li et al, 2021b ; Tan et al, 2021 ; Kuwana et al, 2022 ; Tan et al, 2022 ) societal perspective in four studies, ( Lee et al, 2015 ; Jansen et al, 2017 ; Van De Laar et al, 2020 ; Ha et al, 2021 ) and payer’s perspective in two studies. ( Chen et al, 2019 ; Fatemi et al, 2021 ) All studies used a model-based analytical approach, out of which eleven studies ( Lee et al, 2015 ; Jansen et al, 2017 ; Claxton et al, 2018 ; Chen et al, 2019 ; Schlueter et al, 2019 ; Navarro et al, 2020 ; Li et al, 2021a ; Li et al, 2021b ; Tan et al, 2021 ; Kuwana et al, 2022 ; Tan et al, 2022 ) used an event simulation model, and six studies ( Fournier et al, 2019 ; Muszbek et al, 2019 ; Tian et al, 2020 ; Van De Laar et al, 2020 ; Fatemi et al, 2021 ; Ha et al, 2021 ...…”

“…(Chen et al, 2019;Fatemi et al, 2021) All studies used a model-based analytical approach, out of which eleven studies (Lee et al, 2015;Jansen et al, 2017;Claxton et al, 2018;Chen et al, 2019;Schlueter et al, 2019;Navarro et al, 2020;Li et al, 2021a;Li et al, 2021b;Tan et al, 2021;Kuwana et al, 2022;Tan et al, 2022) used an event simulation model, and six studies (Fournier et al, 2019;Muszbek et al, 2019;Tian et al, 2020;Van De Laar et al, 2020;Fatemi et al, 2021;Ha et al, 2021) 2020) (five-year horizon) used a lifetime horizon for the calculation of costs and QALY (n = 15). (Lee et al, 2015;Jansen et al, 2017;Claxton et al, 2018;Chen et al, 2019;Muszbek et al, 2019;Schlueter et al, 2019;Navarro et al, 2020;Tian et al, 2020;Li et al, 2021a;Li et al, 2021b;Fatemi et al, 2021;Ha et al, 2021;Tan et al, 2021;Kuwana et al, 2022;Tan et al, 2022).…”