Initiation with biologic therapy instead of triple therapy had an incremental cost-effectiveness ratio of $521,520 per quality-adjusted life-year per patient with rheumatoid arthritis, according to a recently published study. The researchers deemed this cost ratio to be not cost-effective.
“Of importance, the implication of this study is not that biologics should be withheld from patients with [rheumatoid arthritis] RA not completely controlled by methotrexate alone. Rather, the study demonstrates the cost savings that would result from prescribing triple therapy first, before a biologic, for such patients,” Nick Bansback, PhD, from the University of British Columbia and St. Paul’s Hospital in Canada, and colleagues wrote. “This study shows that for every patient who tries triple therapy before a biologic, payers will save an average of $78,000 over the patient’s lifetime, and most of that savings will accrue within the first 10 years.”
Researchers assessed a trial of 353 patients with active RA. They examined treatment initiation with either triple therapy of sulfasalazine, hydroxychloroquine and methotrexate or biologic therapy of etanercept and methotrexate.
Investigators found triple therapy had a cost-effectiveness of $0.98 million per quality-adjusted life-year (QALY) vs. $2.7 million per QALY for biologic therapy. In a lifetime analysis, first-line biologic therapy had 0.15 additional QALY compared with triple therapy, but an additional cost of $77,290. The incremental cost-effectiveness ratio of biologic therapy instead of triple therapy was $521,520 per QALY per patient.
“In conclusion, in patients who have RA not adequately controlled by methotrexate alone, we found that the additional costs associated with using etanercept-methotrexate before triple therapy do not provide good value,” the researchers wrote. “Even from a long-term perspective, under optimistic scenarios, first-line therapy with etanercept-methotrexate or other biologics likely is not a cost-effective use of resources compared with using triple therapy first.” – by Will A. Offit
Bansback and colleagues report primary funding from the Cooperative Studies Program, Department of Veterans Affairs Office of Research and Development, Canadian Institutes for Health Research and an interagency agreement with the NIH–American Recovery and Reinvestment Act. Please see the full study for a list of all other authors’ relevant financial disclosures.