Cost-utility analysis of tocilizumab monotherapy in first line versus standard of care for the treatment of rheumatoid arthritis in Greece

Athanasakis, Kostas; Tarantilis, F; Tsalapati, Konstantina; Konstantopoulou, T.; Vritzali, Eleni; Kyriopoulos, John

doi:10.1007/s00296-015-3253-x

Cited by 11 publications

(12 citation statements)

References 47 publications

(50 reference statements)

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“…A lower HAQ score suggests lower RA disease activity and better overall functioning. 17 Consistent with previous U.S. and European peer-reviewed RA models, 14,16,[18][19][20] the HAQ was the primary metric that was correlated with components of QALY (utility and life-years gained), as well as health care utilization and productivityrelated costs. A more favorable (lower) HAQ score is associated with a higher utility, lower likelihood of RA-related mortality, lower hospitalization rates, and higher productivity.…”

Section: Model Structuresupporting

confidence: 63%

Assessing the Value of Sarilumab Monotherapy for Adults with Moderately to Severely Active Rheumatoid Arthritis: A Cost-Effectiveness Analysis

Whittington

McQueen

Ollendorf

et al. 2019

JMCP

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BACKGROUND: Rheumatoid arthritis is associated with a societal burden greater than $39 billion annually. Novel treatments, known as targeted immune modulators (TIMs), are expensive but effective, producing improvements in response rates compared with conventional diseasemodifying antirheumatic drugs (cDMARDs). Sarilumab, a TIM approved in 2017, shows superior improvements compared with cDMARDs and produced significantly greater likelihood of achieving response and improvement in the Health Assessment Questionnaire Disability Index than adalimumab monotherapy. Although sarilumab monotherapy has shown improvements over cDMARDs and the TIM market leader adalimumab, treatment with sarilumab is costly, with an annual wholesale acquisition cost of $39,000. OBJECTIVE: To estimate the lifetime cost-effectiveness of starting treatment with sarilumab monotherapy for adult patients with moderately to severely active rheumatoid arthritis who have had an inadequate response to cDMARDs. What this study addsnet prices led to cost-effectiveness estimates above commonly cited thresholds. When compared with the market leader, sarilumab achieved favorable value. This evaluation informs stakeholders of the value of sarilumab and its alternatives to promote high value practices in health care.

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Section: Model Structuresupporting

confidence: 63%

Assessing the Value of Sarilumab Monotherapy for Adults with Moderately to Severely Active Rheumatoid Arthritis: A Cost-Effectiveness Analysis

Whittington

McQueen

Ollendorf

et al. 2019

JMCP

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“…Like most decision models in RA, we measured disease severity using the HAQ score. [17][18][19][20][21][22] At the start of the simulation, each patient was assigned a HAQ score. The HAQ trajectory over time was then modeled as a function of the treatment sequence considered.…”

Section: ■■ Methods Dose Escalation Data For Etanercept and Adalimumabmentioning

confidence: 99%

The Effect of Dose Escalation on the Cost-Effectiveness of Etanercept and Adalimumab with Methotrexate Among Patients with Moderate to Severe Rheumatoid Arthritis

Incerti¹,

Hernandez

Tkacz

et al. 2020

JMCP

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BACKGROUND: Patients with moderate to severe rheumatoid arthritis (RA) occasionally increase their doses of tumor necrosis factor (TNF) inhibitors, especially the monoclonal antibody origin drugs such as adalimumab and infliximab, after inadequate response to the initial dose. Previous studies have evaluated the cost-effectiveness of various sequences of treatment for RA in the United States but have not considered the effect of dose escalation.OBJECTIVE: To assess the cost-effectiveness of etanercept and adalimumab by incorporating the effect of dose escalation in moderate to severe RA patients. METHODS:We adapted the open-source Innovation and Value Initiative -Rheumatoid Arthritis model, version 1.0 to separately simulate the magnitude and time to dose escalation among RA patients taking adalimumab plus methotrexate or etanercept plus methotrexate from a societal perspective and lifetime horizon. An important assumption in the model was that dose escalation would increase treatment costs through its effect on the number of doses but would have no effect on effectiveness. We estimated the dose escalation parameters using the IBM MarketScan Commercial and Medicare Supplemental Databases. We fit competing parametric survival models to model time to dose escalation and used model diagnostics to compare the fit of the competing models. We measured the magnitude of dose escalation as the percentage increase in the number of doses conditional on dose escalation. Finally, we used the parameterized model to simulate treatment sequences beginning with a TNF inhibitor (adalimumab, etanercept) followed by nonbiologic treatment.

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“…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.…”

Section: Overviewmentioning

confidence: 99%

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

Sussman¹,

Tao²,

Patel

et al. 2020

Journal of Medical Economics

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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.

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Cost-utility analysis of tocilizumab monotherapy in first line versus standard of care for the treatment of rheumatoid arthritis in Greece

Cited by 11 publications

References 47 publications

Assessing the Value of Sarilumab Monotherapy for Adults with Moderately to Severely Active Rheumatoid Arthritis: A Cost-Effectiveness Analysis

Assessing the Value of Sarilumab Monotherapy for Adults with Moderately to Severely Active Rheumatoid Arthritis: A Cost-Effectiveness Analysis

The Effect of Dose Escalation on the Cost-Effectiveness of Etanercept and Adalimumab with Methotrexate Among Patients with Moderate to Severe Rheumatoid Arthritis

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

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