Abatacept for the treatment of patients with rheumatoid arthritis in Argentina: a cost-effectiveness analysis.

ELGART J; GONZALEZ L; AIELLO E

Congreso; 18th Annual International Meeting; 2013

ISPOR

AIM: To estimate the cost-effectiveness of Abatacept in combination with methotrexate (MTX) versus infliximab or tocilizumab in combination with MTX, in patients with rheumatoid arthritis with inadequate response to methotrexate (IR-MTX) in Argentina.METHODS: Adapting a previously validated model, dynamic simulation techniques and clinical data from published literature were used to compare the clinical events, quality of life, and direct medical costs of abatacept, infliximab and tocilizumab. Costs of drug acquisition, administration and monitoring were considered. Costs were calculated from social security system of Argentina (Exchange rate: $ 4.41 Argentinean pesos = 1 US Dollar). A 5-year time horizon was assumed. Costs and health outcomes were discounted at 3% annually. Univariate sensitivity analysis was performed to assess the robustness of the results of the model.RESULTS: A hypothetical cohort of 1,000 patients with RA and IR MTX in Argentina, followed for 5 years, resulted in mean drug costs of: US$70,427, US$80,930, and US$85,986, for abatacept, infliximab and tocilizumab, respectively. Total direct medical costs (discounted) per patient were US$ 78,458 (76,543- 81,290) for abatacept, US$ 89,752 (87,705-95,250) for infliximab, and US$ 93,492 (90,916- 98,903) for tocilizumab. The total QALYs gained (discounted) by abatacept, infliximab and tocilizumab during the same period were: 2.47 (2.41-2.50), 2.39 (2.34-2.43) and 2.39 (2.34-2.43) respectively. Using abatacept as the reference treatment, infliximab and tocilizumab provided less utility at a higher cost, being dominated by abatacept. Sensitivity analysis confirmed the robustness of the model findings. CONCLUSIONS: This study shows that in Argentina, according to the model cost-effectiveness results, abatacept with MTX would be dominant treatment option compared to infliximab and tocilizumab, for patients with rheumatoid arthritis after an inadequate response to MTX