Cost-utility analyses of targeted immunomodulators in rheumatoid arthritis: systematic review

Abstract

Aims: Cost-utility (CU) modeling is a common technique used to determine whether new treatments represent good value for money. As with any modeling exercise, findings are a direct result of methodology choices, which may vary widely. Several targeted immuno-modulators have been launched in recent years to treat moderate-to-severe rheumatoid arthritis (RA) which have been evaluated using CU methods. Our objectives were to identify common and innovative modeling choices in moderateto-severe RA and to highlight their implications for future models in RA. Materials and methods: A systematic literature search was conducted to identify CU models in moderate-to-severe RA published from January 2013 to June 2019. Studies must have included an active comparator and used quality-adjusted life-years (QALYs) as the common measure of effectiveness. Modeling methods were characterized by stakeholder perspective, simulation type, mapping between parameters, and data sources.Results: Thirty-one published modeling studies were reviewed spanning 13 countries and 9 drugs, with common methodological choices and innovations observed among them. Over the evaluated time period, we observed common methods and assumptions that are becoming more prominent in the RA CU modeling landscape, including patient-level simulations, two-stage models combining trial results and real-world evidence, real-world treatment durations, long-term health consequences, and Health Assessment Questionnaire (HAQ)-related hospitalization costs. Models that consider the societal perspective are increasingly being developed as well. Limitations: This review did not consider studies that did not report QALYs as a utility measure, models published only as conference abstracts, or cost-consequence models that did not report an incremental CU ratio. Conclusions: CU modeling for RA increasingly reflects real-world conditions and patient experiences which are anticipated to provide better information in the assessment of health technologies. Future CU models in RA should consider applying the observed advances in modeling choices to optimize their CU predictions and simulation of real-world outcomes.

Cost–utility analysis of tapering strategies of biologicals in rheumatoid arthritis patients in the Netherlands

“…This study has several strengths including the use of a pooled estimate of transition probabilities based on the latest evidence from tapering studies, as well as input data from the real-world Dutch RA patient cohort DREAM. Furthermore, the model does not assume a general deterioration of utility over time, which is consistent with the literature 81. The deliberate inclusion of Dutch-specific citations ensures an accurate reflection of the Dutch market and context, despite potential challenges for non-Dutch readers.…”

HLA -A, -C, -B, -DRB1, -DQB1 and -DPB1 allele and haplotype frequencies in 4514 healthy Norwegians

“…Rheumatoid arthritis is a good example, where several different groups of therapeutic immune modulatory drugs can be used, e.g. cortico-steroids, non-steroid anti-inflammatory drugs, cytostatic or cytotoxic drugs (such as cyclophosphamide) or disease modifying anti-rheumatic drugs (specific or non-specific immune modulating drugs, such as rituximab) [162,163]. Therapeutic approaches often include drugs from these groups successively or in combination.…”