Abstract
Background and ObjectivesEconomic evaluations provide information to aid the optimal utilization of limited healthcare resources. Costs of biologics for Rheumatoid arthritis (RA) are remarkably high, which makes these agents an important target for economic evaluations. This systematic review aims to identify existing studies examining the cost-effectiveness of biologics for RA, assess their quality and report their results systematically.MethodsA literature search covering Medline, Scopus, Cochrane library, ACP Journal club and Web of Science was performed in March 2013. The cost-utility analyses (CUAs) of one or more available biological drugs for the treatment of RA in adults were included. Two independent investigators systematically collected information and assessed the quality of the studies. To enable the comparison of the results, all costs were converted to 2013 euro.ResultsOf the 4890 references found in the literature search, 41 CUAs were included in the current systematic review. While considering only direct costs, the incremental cost-effectiveness ratio (ICER) of the tumor necrosis factor inhibitors (TNFi) ranged from 39,000 to 1 273,000 €/quality adjusted life year (QALY) gained in comparison to conventional disease-modifying antirheumatic drugs (cDMARDs) in cDMARD naïve patients. Among patients with an insufficient response to cDMARDs, biologics were associated with ICERs ranging from 12,000 to 708,000 €/QALY. Rituximab was found to be the most cost-effective alternative compared to other biologics among the patients with an insufficient response to TNFi.ConclusionsWhen 35,000 €/QALY is considered as a threshold for the ICER, TNFis do not seem to be cost-effective among cDMARD naïve patients and patients with an insufficient response to cDMARDs. With thresholds of 50,000 to 100,000 €/QALY biologics might be cost-effective among patients with an inadequate response to cDMARDs. Standardization of multiattribute utility instruments and a validated standard conversion method for missing utility measures would enable better comparison between CUAs.
Highlights
Rheumatoid arthritis (RA) is a chronic autoimmune disease with the prevalence of 0.2–1% among adult population in Europe and North-America [1]
Of the 4890 references found in the literature search, 41 cost-utility analyses (CUAs) were included in the current systematic review
Among patients with an insufficient response to conventional disease-modifying antirheumatic drugs (cDMARDs), biologics were associated with incremental cost-effectiveness ratio (ICER) ranging from 12,000 to 708,000 €/quality adjusted life years (QALY)
Summary
Rheumatoid arthritis (RA) is a chronic autoimmune disease with the prevalence of 0.2–1% among adult population in Europe and North-America [1]. Joint replacement surgery and productivity losses due to sick leave and early retirements lead to significant expenses for society [2]. The treatment target of RA is remission or low disease activity and the medication initially comprises conventional disease-modifying antirheumatic drugs (cDMARDs) such as methotrexate (MTX), sulphasalazine (SSZ), hydroxychloroquine (HCQ) and leflunomide (LEF), low-dose prednisolone and their combinations [3]. Not all patients achieve remission or low disease activity with cDMARDs due to intolerance or lack of effectiveness. Biologics have proven to be an effective treatment for RA, but because of the high price, they are recommended only for patients with insufficient response or intolerance to cDMARDs [3,4,5,6]
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