Cost-utility analysis of certolizumab pegol versus alternative tumour necrosis factor inhibitors available for the treatment of moderate-to-severe active rheumatoid arthritis in Spain

Abstract

BackgroundCertolizumab pegol, a PEGylated tumour necrosis factor (TNF)-inhibitor, improves the clinical signs and symptoms of rheumatoid arthritis (RA) when used in combination with methotrexate or as monotherapy. This study evaluatedthe cost-utility of certolizumab pegol versusTNF-inhibitors plus methotrexate in the treatment of moderate-to-severe RA in Spain.MethodsA Markov cohort health state transition model was developed to evaluate the cost-utility (costs and quality-adjusted life years [QALYs]) of certolizumab pegol versus other TNF-inhibitors licensed in Spain in 2009. Efficacy was measured using the American College of Rheumatology (ACR) responses at 6 months, based on adjusted indirect comparisons from published clinical trials. Utilities were derived from EQ-5D data from certolizumab pegol RA clinical trials. Clinical history and resource use data came from published literature. Unit costs were taken from Spanish databases or published data (cost year 2009). Base case analyses were conducted from the payer perspective, with a lifetime horizon, 3.5 % annual discounting rates for costs and outcomes, and 3 % inflation rate for 2009 onwards. One-way sensitivity analyses were conducted.ResultsThe average lifetime costs for certolizumab pegol, etanercept, adalimumab (every 2 weeks and weekly) and infliximab (3 mg/kg and 5 mg/kg) in combination with methotrexate were €140,971, €141,197, €139,148, €164,741, €136,961 and €152,561, respectively. The QALYs gained were 6.578, 6.462, 6.430 (for both adalimumab doses), 6.430, and 6.318 (for both infliximab doses), respectively. At a €30,000/QALY willingness-to-pay threshold, certolizumab pegol plus methotrexate dominated adalimumab weekly, etanercept, and infliximab 5 mg/kg, and was cost-effective versus adalimumab every 2 weeks and infliximab 3 mg/kg (all with methotrexate), with estimated ICERs of €12,346/QALY and €15,414/QALY, respectively. Certolizumab pegol monotherapy was more cost-effective versus adalimumab, and less expensive with similar health gains versus etanercept (6.416 QALYs vs 6.492). Univariate analysis showed ICERs to be sensitive to changes in time horizon, ACR response time point, baseline Heath Assessment Questionnaire (HAQ) score, and rate of HAQ-disability index deterioration after discontinuing treatment.ConclusionsThis analysis shows that certolizumab pegol is cost-effective compared with other TNF-inhibitors recommended in Spain for the treatment of RA.

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

“…Of the 31 models included in this review, 25 studies were published in peer-reviewed journals 5,[14][15][16][17][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] , five of them were NICE technology appraisals [11][12][13]40,41 , and two models were identified from the gray literature. 42,43 Table 1 provides an overview of each profiled publication.…”

“…14,15,[25][26][27][28][29]42,43 Of the US models, five of them were sponsored by pharmaceutical companies, two of them by academic consortia, and one each was sponsored by an HTA body or an analytics company. Among the other countries, Greece, 16,30 and South Korea 31,32 had two models each, while Colombia, 33 Germany 34 , Iran, 35 Italy, 36 the Netherlands, 37 Norway, 38 Serbia, 39 Spain, 17 and Taiwan 44 had one model each.…”

“…With the launch of new RA treatments such as tofacitinib, baricitinib, upadacitinib, and sarilumab, 10 economic models have been developed and published to analyze their CU in the context of existing and other novel treatments, [11][12][13][14][15][16][17] with the majority of these developed by either manufacturers or health technology assessment (HTA) agencies. The introduction of new RA treatments, along with their CU models, warrant an updated literature review to identify advances in economic models which could be used to inform future CU modeling in RA.…”

Pharmacoeconomic evaluation of treatment effectiveness with selected biologic treatment in rheumatoid arthritis therapy

“…Their results were: infliximab – 7.64, etanercept – 7.66, and adalimumab – 7.64. In one of the latest publications, Hidalgo-Vega [ 18 ] also benefited from the Markov model, obtaining QALY for infliximab 6.318, etanercept 6.462, and for adalimumab 6.430. Chen et al [ 7 ] compiled a comprehensive report on the cost-effectiveness analysis of biological medications, especially paying attention to treatment with infliximab, etanercept, and adalimumab.…”

Pharmacoeconomics of JAK inhibitors in patients with rheumatoid arthritis who had inadequate response to conventional synthetic disease- modifying antirheumatic drugs

“…При оценке QALY на основе частоты достижения ACR20, ACR50 и ACR70 рассчитывали снижение счета HAQ-DI (при достижении ACR20 -на 0,80, ACR50 -на 0,95, ACR70 -на 1,07) [5] c последующим пересчетом в показатель полезности. Изменение показателя полезности (качества жизни) рассчитывали по формуле ΔКЖ = −0,2102 × Δ HAQ [6].…”