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Cost-utility analysis of tocilizumab monotherapy in first line versus standard of care for the treatment of rheumatoid arthritis in Greece

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Abstract

The study aims to evaluate the cost-effectiveness of adding tocilizumab (TCZ) first line to a treatment sequence for patients with active rheumatoid arthritis (RA), who had an inadequate response to one or more traditional synthetic disease-modifying antirheumatic drugs (DMARDs) and are intolerant to methotrexate (MTX), or in whom continued treatment with MTX is considered inappropriate. An individual simulation model was applied to project lifetime costs and outcomes for 10,000 patients from a payer’s perspective. The analysis compared the standard treatment pathway (STP) with a similar pathway, where treatment was initiated with TCZ. QALYs were used as primary efficacy outcomes. Efficacy data were obtained from the ADACTA trial and a network meta-analysis. Clinical practice standards were derived from an expert panel of Greek rheumatologists. Results indicate that a treatment sequence starting with TCZ yields 1.17 more QALYs (9.38 vs. 8.21) at an additional cost of €33,744 (€119,840 vs. €86,096) compared with the STP. The incremental cost-effectiveness ratio was €28,837/QALY gained. Probabilistic sensitivity analysis confirms robustness of these findings as consistently below a threshold of €45,000. The results of the analysis suggest that TCZ, when used as a first-line biologic monotherapy, can be a cost-effective treatment option for the management of active RA in patients in need of biologic monotherapy.

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Acknowledgments

The present study was financially supported by Roche Hellas S.A.

Conflict of interest

The Department of Health Economics of the National School of Public Health was financially supported via research grant from Roche Hellas S.A. for the completion of this study. AK, FT, KT and JK are affiliated to the Department of Health Economics of the National School of Public Health. TK and EV have disclosed that they are former employees of Roche Hellas S.A.

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Authors and Affiliations

  1. Department of Health Economics, National School of Public Health, 196 Alexandras Avenue, 11521, Athens, Greece

    Kostas Athanasakis, Filippos Tarantilis, Konstantina Tsalapati & John Kyriopoulos

  2. Athens, Greece

    Thomais Konstantopoulou (HEOR & Market Access Consultant) & Eleni Vritzali MD (Rheumatologist)

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  1. Kostas Athanasakis
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  2. Filippos Tarantilis
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  3. Konstantina Tsalapati
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  4. Thomais Konstantopoulou
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  5. Eleni Vritzali MD
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Correspondence to Filippos Tarantilis.

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Athanasakis, K., Tarantilis, F., Tsalapati, K. et al. Cost-utility analysis of tocilizumab monotherapy in first line versus standard of care for the treatment of rheumatoid arthritis in Greece. Rheumatol Int 35, 1489–1495 (2015). https://doi.org/10.1007/s00296-015-3253-x

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