DMARDs more cost effective, achieve similar outcomes vs. TNF inhibitors in RA
Initiating treatment with intensive combinations of conventional disease modifying antirheumatic drugs achieves comparable outcomes as treatment with TNF inhibitors, but at a significantly lower cost, among patients with rheumatoid arthritis, according to data published in Arthritis Care & Research.
“This study is important because biologic drugs like TNF inhibitors are substantially more expensive than conventional DMARDs,” Anita Patel, PhD, of Anita Patel Health Economics Consulting, told Healio Rheumatology. “It is thus legitimate to question what additional value they bring, especially for resource-limited health care systems.”
To analyze whether intensive combinations of conventional DMARDs could result in clinical benefits similar to TNF inhibitors, but for a lower price, in patients with active RA, Patel and colleagues conducted a pre-planned economic evaluation within the larger TACIT trial. According to the researchers, the TACIT trial was an open-label, 12-month, pragmatic, randomized, multicenter noninferiority study that compared conventional DMARD and TNF inhibitors treatment strategies for RA. Participants included 101 patients in the TNF inhibitor group and 104 in the conventional DMARD cohort, all of whom had previously failed to respond to methotrexate and another DMARD.
Patel and colleagues determined cost effectiveness using the trial’s primary outcome measure, the health assessment questionnaire, with cost-utility analyses based on quality-adjusted life years, derived from the Short Form 36 (SF-36) and the EuroQuol 5-Dimension measure (EQ5D3L). These measures were administered at baseline as well as 6 and 12 months. Participants in the conventional DMARD group who demonstrated poor responses to treatment at 6 months were offered the opportunity to switch to TNF inhibitors treatment. A total of 46 patients opted to switch.
In the final analysis, relevant cost and outcome data were available for 93% of participants at 6 months, and for 91% to 92% at 12 months.
According to the researchers, patients in the conventional DMARD group experienced significantly lower cost totals from all perspectives (6-month health and social care adjusted mean difference = –£3,615; 95% CI, –4,104 to –3,182). In addition, analysis of health assessment questionnaires demonstrated benefit to conventional DMARD treatment at 12 months (–0.16; 95% CI, –0.32 to –0.01). No other differences were observed in additional outcomes or follow-ups.
“For patients with established RA who have failed to respond to methotrexate and another DMARD, starting treatment with conventional DMARDs provides equivalent outcomes to starting treatment with TNF inhibitors at 12 months, and either avoids or delays the additional costs associated with the more expensive TNF inhibitors,” Patel said. “Such a treatment strategy therefore offers a pragmatic response to financial challenges presented by new and more expensive treatments.” – by Jason Laday
Disclosure: Patel reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.