OBJECTIVES

The progression of moderate and severe rheumatoid arthritis (RA) is controlled for many patients by biologic disease modifying anti-rheumatic drugs (bDMARDs). However, once patients become eligible for these therapies, they often face a delay in starting treatment, largely due to cost concerns. This analysis aimed to evaluate the economic impact of these delays in biologic treatment, adapting a published cost-effectiveness framework to a German societal perspective.

METHODS

A semi-Markov cohort model was developed, with a cycle length of 6 months and a time horizon of 50 years. Cost and Quality Adjusted Life-Years (QALYs) were discounted at an annual rate of 5%.

A sequence of bDMARDs beginning with immediate initiation of AMGEVITA^® (adalimumab) was compared to the same sequence in the comparator arm starting with a 6-month delay of originator adalimumab. During the delay, patients are assumed to continue conventional therapy. Treatment effects were modeled on patients’ Health Assessment Questionnaire (HAQ) scores, which in turn determined economic and quality of life outcomes. Cost inputs were taken from local sources, and comparative efficacy and utility estimates were collected from peer-reviewed literature.

For each arm, the model estimates the total direct costs, life-years (LYs) and QALYs. The results of the model were used to derive the incremental cost-effectiveness ratio (ICER).

RESULTS

The comparator arm, including the treatment delay, resulted in total discounted costs of €247,409, together with 20.590 LYs and 7.662 discounted QALY. Earlier intervention with AMGEVITA resulted in total discounted costs of €224,127, together with 20.619 LYs and 7.710 discounted QALYs. With a cost reduction of €23,282 and incremental QALYS and LYs of 0.047 and 0.029, respectively, earlier intervention with AMGEVITA dominated later intervention with originator adalimumab.

CONCLUSIONS

The availability of AMGEVITA allows eligible RA patients to be treated earlier with biologics, whilst simultaneously reducing the costs of treating RA versus the originator.