PMS56 - COST-EFFECTIVENESS ANALYSIS OF SUBCUTANEOUS TOCILIZUMAB WITHOUT METHOTREXATE IN RHEUMATOID ARTHRITIS TREATMENT

Abstract

Rheumatoid Arthritis (RA) treatment has advanced in the recent years after developments of biologic agents. In this study, a cost-effectiveness analysis was performed for treatment with subcutaneous (SC) tocilizumab monotherapy and standard of care (SoC) from the Turkish healthcare payer's perspective. The primary endpoint of the study was incremental cost-effectiveness ratio (ICER) gained per quality-adjusted life years (QALY). Two alternative “lines of treatment” for RA patient population were compared, one reflecting those patients for whom a SoC treatment can be maintained for a lifetime versus those patients who are traditional DMARD-IR, MTX-IR or have a MTX contraindication. Treatment response was represented by the Health Assessment Questionnaire (HAQ) score that can be converted to the disease severity benefit value (QALY) with American College of Rheumatology (ACR) response rates. Adverse effects reported for biologic DMARDs were also included in the calculations. In the analysis with individual sampling model, line of therapy involving tocilizumab-SC was evaluated together with lines of bDMARD therapies including adalimumab, certolizumab pegol and etanercept. The model also included tDMARDs that are reimbursed in Turkey including leflunomide and cyclosporine, assuming that patients could switch back to tDMARDs following inadequate response to bDMARDs. Both treatment approaches were completed with palliative care. Probabilistic sensitivity analysis (PSA) was performed. 3,5% discount was applied to costs and effectiveness figures. Lifetime tocilizumab-SC related total cost per patient was 69.293,4 TRY compared to 69.300,6 TRY for SoC. Treatment with tocilizumab-SC yielded 8,618 QALY compared with 7,978 QALY with SoC. ICER was -11,3 TRY for the line of therapy involving tocilizumab-SC compared with SoC. PSA and ICER yielded comparable results to the indicative results of the base-case scenario. The study showed that SC tocilizumab was a cost-saving (dominant) health technology compared with SoC for the treatment of RA in Turkey.