Skip to main content

Advertisement

SpringerLink
Log in

Rituximab as first choice for patients with refractory rheumatoid arthritis: cost-effectiveness analysis in Iran based on a systematic review and meta-analysis

  • Health Services Research
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

The aim of this study was to evaluate the effectiveness and cost-effectiveness of using rituximab as first line for patients with refractory rheumatoid arthritis in comparison with continuing conventional DMARDs, from a perspective of health service governors. A systematic review was implemented through searching PubMed, Scopus and Cochrane Library. Quality assessment was performed by Jadad scale. After meta-analysis of ACR index results, QALY gain was calculated through mapping ACR index to HAQ and utility index. To measure the direct and indirect medical costs, a set of interviews with patients were applied. Thirty-two patients were selected from three referral rheumatology clinics in Tehran with definite diagnosis of refractory rheumatoid arthritis in the year before and treatment regimen of either rituximab or DMARDs within last year. Incremental cost-effectiveness ratio was calculated for base case and scenario of generic rituximab. Threefold of GDP per capita was considered as threshold of cost-effectiveness. Four studies were eligible to be considered in this systematic review. Total risk differences of 0.3 for achieving ACR20 criteria, 0.21 for ACR50 and 0.1 for ACR70 were calculated. Also mean of total medical costs of patients for 24 weeks were $3985 in rituximab group and $932 for DMARDs group. Thus, the incremental cost per QALY ratio will be $45,900–$70,223 in base case and $32,386–$49,550 for generic scenario. Rituximab for treatment of patients with refractory rheumatoid arthritis is not considered as cost-effective in Iran in none of the scenarios.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Venables P, Maini R (2014) Clinical features of rheumatoid arthritis. In: Basow DS (ed) UpToDate. UpToDate, Waltham, MA

  2. Lipsky PE et al (2008) Rheumatoid arthritis. In: Fauci AS, Braunwald E, Kasper DL et al (eds) Harrison’s principles of internal medicine, 17th edn. McGraw-Hill, New York, p 2083

    Google Scholar 

  3. Davatchi F (2009) Rheumatology in Iran. Int J Rheum Dis 12(4):283–287. doi:10.1111/j.1756-185X.2009.01425.x

    Article  PubMed  Google Scholar 

  4. Selection of results of census 2012 (2014) Statistical Center of Iran. http://www.amar.org.ir/Portals/0/Files/abstract/1390/sarshomari90_nahaii.pdf. Accessed 08 July 2014

  5. Schur PH, Gabriel SE, Crowson CS (2014) Epidemiology of, risk factors for, and possible causes of rheumatoid arthritis. In: Basow DS (ed) UpToDate. UpToDate, Waltham

    Google Scholar 

  6. Yee CS, Filer A, Pace A, Douglas K, Situnayake D, Rowe IF, West Midlands Rheumatology S, Training C (2003) The prevalence of patients with rheumatoid arthritis in the West Midlands fulfilling the BSR criteria for anti-tumour necrosis factor therapy: an out-patient study. Rheumatology (Oxford, England) 42(7):856–859. doi:10.1093/rheumatology/keg231

    Article  CAS  Google Scholar 

  7. Balk RA (2014) Methotrexate-induced lung injury. In: Basow DS (ed) UpToDate. UpToDate, Waltham

    Google Scholar 

  8. Curtis JR, Beukelman T, Onofrei A, Cassell S, Greenberg JD, Kavanaugh A, Reed G, Strand V, Kremer JM (2010) Elevated liver enzyme tests among patients with rheumatoid arthritis or psoriatic arthritis treated with methotrexate and/or leflunomide. Ann Rheum Dis 69(1):43–47. doi:10.1136/ard.2008.101378

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Wallace DJ (2014) Antimalarial drugs in the treatment of rheumatic disease. In: Basow DS (ed) UpToDate. UpToDate, Waltham

    Google Scholar 

  10. Weisman MH, Rinaldi RZ (2014) Sulfasalazine in the treatment of rheumatoid arthritis. In: Basow DS (ed) UpToDate. UpToDate, Waltham

    Google Scholar 

  11. Leandro MJ (2014) Rituximab and other B cell targeted therapies for rheumatoid arthritis. In: Basow DS (ed) UpToDate. UpToDate, Waltham

    Google Scholar 

  12. Edwards JCW, Szczepański L, Szechiński J, Filipowicz-Sosnowska A, Emery P, Close DR, Stevens RM, Shaw T (2004) Efficacy of B-cell-targeted therapy with rituximab in patients with rheumatoid arthritis. N Engl J Med 350(25):2572–2581

    Article  CAS  PubMed  Google Scholar 

  13. Burton W, Morrison A, Maclean R, E R (2006) Systematic review of studies of productivity loss due to rheumatoid arthritis. Occup Med (Lond) 56(1):18–27

    Article  Google Scholar 

  14. Osiri M, Maetzel A, P T (2007) The economic burden of rheumatoid arthritis in a developing nation: results from a one-year prospective cohort study in Thailand. J Rheumatol 34(1):57–63

    PubMed  Google Scholar 

  15. GDP per capita (current US$) (2014) World Bank. http://data.worldbank.org/indicator/NY.GDP.PCAP.CD. Accessed 08 July 2014

  16. Jadad AR, Moore RA, Carroll D, Jenkinson C, Reynolds DJ, Gavaghan DJ, McQuay HJ (1996) Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials 17(1):1–12

    Article  CAS  PubMed  Google Scholar 

  17. Kielhorn A, Porter D, Diamantopoulos A, Lewis G (2008) UK cost-utility analysis of rituximab in patients with rheumatoid arthritis that failed to respond adequately to a biologic disease-modifying antirheumatic drug. Curr Med Res Opin 24(9):2639–2650. doi:10.1185/03007990802321683

    Article  CAS  PubMed  Google Scholar 

  18. Bansback NJ, Brennan A, Ghatnekar O (2005) Cost effectiveness of adalimumab in the treatment of patients with moderate to severe rheumatoid arthritis in Sweden. Ann Rheum Dis 64(7):995–1002. doi:10.1136/ard.2004.027565

    Article  CAS  PubMed  Google Scholar 

  19. Boggs R, Sengupta N, Ashraf T (2002) Estimating health utility from a physical function assessment in rheumatoid arthritis (RA) patients treated with adalimumab (HUMIRA) [abstract]. International Society of Pharmacoeconomics and Outcomes Research abstract UT3:452–453

  20. Carreno A, Fernandez I, Badia X, Varela C, Roset M (2011) Using HAQ-DI to estimate HUI-3 and EQ-5D utility values for patients with rheumatoid arthritis in Spain. Value Health 14(1):192–200. doi:10.1016/j.jval.2010.11.001

    Article  PubMed  Google Scholar 

  21. Table: threshold values for intervention cost-effectiveness by Region (2014) World Health Organization. http://www.who.int/choice/costs/CER_levels/en/index.html. Accessed 08 July 2014

  22. Cohen SB, Emery P, Greenwald MW, Dougados M, Furie RA, Genovese MC, Keystone EC, Loveless JE, Burmester GR, Cravets MW, Hessey EW, Shaw T, Totoritis MC (2006) Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy: results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial evaluating primary efficacy and safety at twenty-four weeks. Arthr Rheum 54(9):2793–2806. doi:10.1002/art.22025

    Article  CAS  Google Scholar 

  23. Emery P, Fleischmann R, Filipowicz-Sosnowska A, Schechtman J, Szczepanski L, Kavanaugh A, Racewicz AJ, van Vollenhoven RF, Li NF, Agarwal S, Hessey EW, Shaw TM (2006) The efficacy and safety of rituximab in patients with active rheumatoid arthritis despite methotrexate treatment: results of a phase IIB randomized, double-blind, placebo-controlled, dose-ranging trial. Arthr Rheum 54(5):1390–1400. doi:10.1002/art.21778

    Article  CAS  Google Scholar 

  24. Emery P, Deodhar A, Rigby WF, Isaacs JD, Combe B, Racewicz AJ, Latinis K, Abud-Mendoza C, Szczepanski LJ, Roschmann RA, Chen A, Armstrong GK, Douglass W, Tyrrell H (2010) Efficacy and safety of different doses and retreatment of rituximab: a randomised, placebo-controlled trial in patients who are biological naive with active rheumatoid arthritis and an inadequate response to methotrexate (Study Evaluating Rituximab’s Efficacy in MTX iNadequate rEsponders (SERENE)). Ann Rheum Dis 69(9):1629–1635. doi:10.1136/ard.2009.119933

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor (2010) NICE technology appraisal guidance. http://publications.nice.org.uk/adalimumab-etanercept-infliximab-rituximab-and-abatacept-for-the-treatment-of-rheumatoid-ta195/evidence-and-interpretation. Accessed 08 July 2014

  26. Lindgren P, Geborek P, Kobelt G (2009) Modeling the cost-effectiveness of treatment of rheumatoid arthritis with rituximab using registry data from southern Sweden. Int J Technol Assess Healthc 25(2):181–189. doi:10.1017/s0266462309090230

    Article  Google Scholar 

  27. Drug treatment for rheumatoid arthritis (2014) NICE. http://pathways.nice.org.uk/pathways/rheumatoid-arthritis/drug-treatment-for-rheumatoid-arthritis#. Accessed 08 July 2014

  28. Mota LMHD, Cruz BA, Brenol CV, Pereira IA, Rezende-Fronza LS, Bertolo MB, Freitas MVC, Silva NAD, Louzada-Junior P, Giorgi RDN, Lima RAC, Bernardo WM, Pinheiro GDRC (2012) Guidelines for the drug treatment of rheumatoid arthritis. Rev Bras Reumatol 53(2):158–183

    Article  Google Scholar 

  29. Schur PH, Cohen S (2014) Treatment of rheumatoid arthritis resistant to initial DMARD therapy in adults. In: Basow DS (ed) UpToDate. UpToDate, Waltham

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pharmacoeconomics and Pharmaceutical Administration, and Pharmaceutical Policy Research Center, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran

    Saeed Ahmadiani, Shekoufeh Nikfar & Abbas Kebriaeezadeh

  2. Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Somayeh Karimi

  3. Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

    Ahmad Reza Jamshidi

  4. Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

    Ali Akbari-Sari

  5. Iran Food and Drug Administration, Fakhre-Razi St., Enghelab St, Tehran, Iran

    Shekoufeh Nikfar

Authors
  1. Saeed Ahmadiani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shekoufeh Nikfar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Somayeh Karimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ahmad Reza Jamshidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ali Akbari-Sari
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Abbas Kebriaeezadeh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shekoufeh Nikfar.

Ethics declarations

Conflict of interest

Any conflict of interest is disclaimed by all of the authors.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Inform consent was obtained from all individual participants prior to interview.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 17 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ahmadiani, S., Nikfar, S., Karimi, S. et al. Rituximab as first choice for patients with refractory rheumatoid arthritis: cost-effectiveness analysis in Iran based on a systematic review and meta-analysis. Rheumatol Int 36, 1291–1300 (2016). https://doi.org/10.1007/s00296-016-3484-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-016-3484-5

Keywords

Search

Navigation