PMS56 - Economic Analysis of Biologic Alternatives In The Management of Rheumatoid Arthritis, Psoriasis and ankylosing Spondylitis From Public and Private Perspectives in Brazil

Abstract

This study aims to perform a cost-effectiveness analysis of biologic alternatives for rheumatoid arthritis (RA), psoriasis (PSO) and ankylosing spondylitis (AS) in Brazil, from public and private perspectives. A decision tree model was developed for AR and PSO to evaluate the cost-effectiveness of biological drugs (etanercept, adalimumab, infliximab, tocilizumab, abatacept and rituximab). Effectiveness measures were extracted from literature and outcomes included: ACR20 and ACR70 responses, and HQA for RA; and PASI 75 success rate for PSO. Only costs were compared for AS because the model assumed the same effectiveness for drugs, according to literature review. Direct medical costs included biological acquisition, adverse events management and infusion (if applicable), presented in 2014 BRL. From the public perspective, in AR, etanercept was the most cost-effective option when compared to others drugs for all measures (158,731 BRL for ACR20, 282,448 BRL for ACR70 and 121,946 BRL for HAQ), followed by adalimumab, infliximab and tocilizumab, and rituximab. The same result was observed for PSO. Etanercept showed a cost-effectiveness ratio per PASI 75 response of 104,820 BRL versus 110,886 BRL for adalimumab. From the private perspective, once again etanercept was the most cost-effective option for all evaluated diseases. In RA, the cost-effectiveness ratios per ACR20, ACR70 and HAQ were 193,211 BRL, 343,802 BRL, 148,435 BRL, respectively, and in PSO the value observed per PASI 75 response was 133,871 BRL versus 179,607 BRL for adalimumab and 268,504 BRL for infliximab. In AS, from both perspectives, etanercept represented the least costly option: 55,581 BRL versus 69,602 BRL for infliximab (public); 70,985 BRL versus 75,435 BRL for adalimumab and 99,883 BRL for infliximab (private). Etanercept showed the best cost-effectiveness ratio and lower costs when compared to others biological drugs in the management of AR, PSO and AS, from both Brazilian perspectives.