Biologic Therapy Not Cost-Effective in Patients With RA

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).


Related Content

Certolizumab combo helps curb RA damage

Methotrexate "dramatically" underused for RA


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