PMS42 Cost-Utility of Tocilizumab Monotherapy in Methotrexate Intolerant/Contra-Indicated, Moderate/Severe Rheumatoid Arthritis Patients in Portugal

Abstract

analysis, showed 89.2% of iterations favored denosumab. CONCLUSIONS: Denosumab was cost-effective over zoledronate from the private health care setting perspective in Brazil, adding gains in benefits at a lower cost in preventing osteoporotic fractures in postmenopausal women. OBJECTIVES:To explore the cost-utility of adding tocilizumab (TCZ) monotherapy to current monotherapy treatment sequences in moderate/severe adult rheumatoid arthritis (RA) patients with inadequate response to one or more disease-modifying antirheumatic drugs (DMARD-IR) and intolerance/contra-indication to methotrexate (MTX) in Portugal. METHODS: A cost-utility analysis was conducted with a societal perspective. The analysis considered two scenarios: a treatment sequence starting with TCZ followed by two tumor necrosis factor inhibitors (anti-TNF), adalimumab (ADA) and etanercept (ETA) and palliative care (PC) -scenario 1 -or ETA, ADA and PC -scenario 2 -compared to the same treatment sequence without TCZ. Patients characteristics (age, starting HAQ-DI score and gender) were based on TCZ randomized clinical trial (RCT) data in monotherapy. ACR response data for the other biologic treatments were sourced from corresponding published RCTs in monotherapy. A mapping model was used to assign QALYs to patients based on HAQ-DI scores and EQ-5D collected in other RCTs (Kremer J, 2008; Smolen JS, 2008). Resource utilization was estimated based on a Portuguese rheumatolo-gists= expert panel. Unit costs were obtained from Portuguese official sources. Costs and QALYs were discounted annually at 5%. Uncertainty around the model key parameters was explored via probabilistic sensitivity analysis (PSA). RESULTS: The model estimated that the treatment sequences starting with TCZ result in higher QALYs and additional costs versus comparator sequences. The incremental costeffectiveness ratios (ICER) in both scenarios is below a threshold of 30.000€ per QALY gained. Sensitivity analysis and PSA showed that results are robust to parameter changes. CONCLUSIONS: Results of this analysis suggest that TCZ in monotherapy, added as first line biologic to currently used anti-TNF monotherapy sequences, represents an efficacious and cost-effective alternative to sequences currently used for treating MTX intolerant/contra-indicated RA patients in Portugal.

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

“…Nonetheless, TCZ's favorable cost-effectiveness (from €13,220/QALY to €36,900/QALY) as a monotherapy Fig. 2 Cost-effectiveness scatterplot was demonstrated by findings of economic evaluations performed in the USA [40], Turkey [41], Spain [42], Portugal [43], Scotland [44], UK [45] and Romania [46]. A UK-based study [47], using a similar research design and model, reports an ICER of £7,289/QALY for TCZ first line and an ICER of £11,400/QALY for TCZ second line, leading to the notion that the current study's findings could be regarded rather conservative.…”