PMS19 - Cost Per Response of Certolizumab Pegol Versus Adalimumab Among Biologic-Naïve Patients With Moderate or Severe Rheumatoid Arthritis from the US Payer Perspective

Abstract

Biologics are effective in managing rheumatoid arthritis (RA) but switching as early as 3 months into treatment due to primary non-response, or later due to lack of durability, is common. This analysis compared the cost per response (low disease activity [LDA]) between certolizumab pegol (CZP) and adalimumab (ADA) using EXXELERATE trial data from the US payer perspective. EXXELERATE (NCT01500278) was a phase IV, 104-week (Wk) randomized, head-to-head, superiority study comparing CZP+methotrexate (MTX) with ADA+MTX, for the treatment of moderate/severe RA. At Wk12 patients not achieving LDA, Disease Activity Score 28-joint erythrocyte sedimentation rate [DAS28-ESR] ≤3.2, or DAS28-ESR reduction from baseline ≥1.2, switched biologic treatment (CZP to ADA/ADA to CZP). Patients who switched treatment at Wk12 and/or withdrew at Wk24 due to non-response were classified as non-responders for subsequent timepoints. Downstream non-responder costs, including costs of patients that obtained a response after treatment switch, were attributed to the initial treatment used. Cost per response at Wk52 and Wk104 were calculated as: total cost among responders+non-responders divided by number of responders. Direct healthcare resource utilization use was estimated from EXXELERATE data; associated costs were derived from the RED BOOK™, Medicare fee schedule, Healthcare Cost and Utilization Project database, and published literature. 908 patients (454 per arm) were included in this analysis. LDA response rates were comparable between CZP and ADA at Wk52 (42% vs 39%) and Wk104 (36% vs 34%). Costs per LDA response for CZP vs ADA were $120,131 vs $133,974 (Wk52), and $237,607 vs $275,449 (Wk104), a difference of $13,843 and $37,842 respectively, primarily driven by drug cost. The EXXELERATE trial demonstrated the effective use of two sequential biologics in the same class to effectively control RA. CZP treatment was associated with lower one-year and two-year costs per LDA compared to ADA treatment.