A cost-effectiveness analysis showed that patients with rheumatoid arthritis (RA) who switch from a disease-modifying antirheumatic drug (DMARD) to a biologic drug are likely to increase costs of care while receiving only minimal incremental benefit, published in Annals of Internal Medicine (published online May 30, 2017; doi:10.7326/M16-0713).
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Patients with RA usually begin their treatment with conventional DMARDs. Current guidelines from the American College of Rheumatology recommend switching therapy to a biologic drug if initial symptoms persist. A recent study (RACAT) showed that switching to a triple therapy—comprised of sulfasalazine, hydroxychloroquine, and methotrexate—is equally as effective as switching to a biologic drug. However, a cost-effectiveness analysis has yet to compare the two approaches.
Nick Bansback, PhD, University of British Columbia (Canada), and colleagues conducted a study to determine the cost-effectiveness of etanercept-methotrexate compared with triple therapy as a first-line strategy for patients with RA with persisting symptoms. Researchers undertook a within-trial analysis based on 353 patients in the RACAT trial, as well as a lifetime analysis that determined costs and outcomes using a decision analytic cohort model. All of the sampled patients continued to have persisting RA symptoms after at least 12 weeks of methotrexate therapy.
Incremental costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs) were measured after 24 months and estimated for lifetime.
Results of the within-trial analysis showed that etanercept-methotrexate offered only marginally more QALYs to patients, while accumulating significantly higher drug costs. ICERs for the etanercept-methotrexate were $2.7 million per QALY over 24 weeks and $0.98 million per QALY over 48 weeks.
Lifetime analysis estimates suggest that etanercept-methotrexate treatment would result in 0.15 additional lifetime QALYs, but would cost an incremental $77,290 and a subsequent ICER of $521,520 per QALY per patient.
Authors of the study concluded that “Considering a long-term perspective, an initial strategy of etanercept–methotrexate and biologics with similar cost and efficacy is unlikely to be cost-effective compared with using triple therapy first, even under optimistic assumptions.”—Zachary Bessette
