Abstract
BackgroundTo analyse the cost-effectiveness of traditional disease-modifying anti-rheumatic drugs (tDMARDs) compared to biological therapies from the perspective of Chinese society.Methodology/Principal FindingsA mathematical model was developed by incorporating the clinical trial data and Chinese unit costs and treatment sequences from a lifetime perspective. Hypothetical cohorts with moderate to severe RA were simulated. The primary outcome measure–quality-adjusted life years (QALYs)–was derived from disease severity (HAQ scores). Primary analysis included drug costs, monitoring costs, and other costs. Probabilistic and one-way sensitivity analyses were performed. Treatment sequences that included TNF antagonists and rituximab produced a greater number of QALYs than tDMARDs alone or TNF antagonists plus DMARDs. In comparison with tDMARDs, the incremental cost-effectiveness ratios (ICERs) for etanercept, infliximab, and adalimumab without rituximab were $77,357.7, $26,562.4 and $57,838.4 per QALY and $66,422.9, $28,780.6 and $50,937.6 per QALY, for etanercept, infliximab, and adalimumab with rituximab. No biotherapy was cost-effective under the willingness to pay threshold when the threshold was 3 times the per capita GDP of China. When 3 times the per capita GDP of Shanghai used as the threshold, infliximab and rituximab could yield nearly 90% cost-effective simulations in probabilistic sensitivity analysis.Conclusions/SignificancetDMARD was the most cost-effective option in the Chinese healthcare setting. In some relatively developed regions in China, infliximab and rituximab may be a favorable cost-effective alternative for moderate to severe RA.
Highlights
Rheumatoid arthritis (RA), with a prevalence rate unmet of 0.2% to 0.37% in China [1,2], is a systemic autoimmune disease that causes chronic inflammation of the joints and tendons resulting in progressive bony erosions and joint damage
The hypothetical patient would receive one of the following seven competing strategies to manage active moderate to severe RA: traditional disease-modifying anti-rheumatic drugs (tDMARDs) only, initiation with etanercept followed by tDMARD, initiation with infliximab followed by tDMARD, initiation with adalimumab followed by tDMARD, etanercept therapy followed by rituximab and tDMARD
(etanercept + rituximab strategy), infliximab therapy followed by rituximab and tDMARD and adalimumab therapy followed by rituximab and tDMARD
Summary
Rheumatoid arthritis (RA), with a prevalence rate unmet of 0.2% to 0.37% in China [1,2], is a systemic autoimmune disease that causes chronic inflammation of the joints and tendons resulting in progressive bony erosions and joint damage. When treatment efficacy with these regimens declines, patients usually need to switch regimens or the disease becomes more active and progressive. Licensed biological agents, such as tumor necrosis factor (TNF)-a inhibitors, the costimulatory molecule inhibitor (abatacept), the B-cell depletion agent (rituximab), and the interleukin-6 receptor inhibitor (tocilizumab), have greatly enhanced effective RA treatment and improved health outcomes [4,5,6]. To analyse the cost-effectiveness of traditional disease-modifying anti-rheumatic drugs (tDMARDs) compared to biological therapies from the perspective of Chinese society
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
