PMS16 Economic Evidence of Biologics in Rheumatoid Arthritis: A Systematic Review for Supporting Informed Decision of BNHI

Abstract

In November 2011, Center for Drug Evaluation completed the project which aimed to re-evaluate the currently reimbursed biologics for rheumatoid arthritis (RA), and to establish the evidence-based revision rules of reimbursed items covered by National Health Insurance (NHI). As part of the project, this study reviewed the cost-effectiveness of reimbursed biologics (etanercept, adalimumab and rituximab) and other non-reimbursed biologics for adult patients. Electronic databases including PubMed, CEPS (Chinese Electronic Periodical Services) and CETD (Chinese Electronic Theses and Dissertation Service) were searched up to October 2011. A total of 130 articles were reviewed and 37 were identified. The SIGN 50 instrument was subsequently applied to assess the quality of evidence. To present the differences among studies, we summarized the cost-effectiveness of biologics for DMARD-IR (inadequate response to disease-modifying anti-rheumatic drugs) and TNF-IR patients (inadequate response to tumor necrosis factor-alpha inhibitors), respectively. For DMARD-IR patients, twenty cost-effectiveness analyses (CEAs), most of high quality, were included. In summary, two reimbursed biologics including etanercept and adalimumab were considered as cost-effective alternatives in most foreign insurers comparing with DMARDs. Combination therapies of biologics and methotrexate were cost-effective comparing with monotherapy of biologics. However, the findings were still inconsistent when comparing etanercept with adalimumab, For TNF-IR patients, 10 CEAs, most of high quality, were included. Overall, rituximab was considered cost-effective in most foreign insurers. Existing studies suggested that the reimbursed biologics were cost-effective alternatives in most foreign countries. Nevertheless the cost-effectiveness of technologies might vary across countries, because the health care setting, clinical pattern, characteristics of patients, and relative prices are difference in nature. A localized decision analytic model is still needed for more relevant and precise assessment. This review, however, limited by the research resource, provided only the preliminary evidence to inform the decision making.