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Cost-effectiveness treatment with Rituximab in patients with rheumatoid arthritis in real life

Rheumatology International volume 31, pages 1465–1469 (2011)Cite this article

Abstract

The cost-effectiveness of treatments that have the potential to change the “natural history” of a chronic progressive disease has to be evaluated over the long term. Cost-effectiveness estimates have been based on the concept that, with treatment, patients will not progress to the next level(s) of disease severity or will take a longer time to progress, thus avoiding or delaying the high costs and low utility associated with more severe disease. This analysis focused on the use of Rituximab in treating patients with moderate to severe RA for whom at least one anti-TNFα blocking agent had failed. The aim of our study was to evaluate the cost-effectiveness in 32 patients with rheumatoid arthritis in therapy with a single infusion of Rituximab 1,000 mg given on days 1 and 15 of each month for 1 year. After 6 months of treatment, we observed for all 32 patients a total quality-adjusted life year (QALY) gained of 11,840 with an average of 0.37 QALY for a single patient, a treatment cost of €5,610 and a QALY/cost ICER (incremental cost-effectiveness ratio) of €15,114. After 1 year of treatment, we observed data for 28 patients with a total QALY gained of 11,480 with an average of 0.41 QALY for a single patient, a treatment cost of €9,690 and a QALY/cost ICER (incremental cost-effectiveness ratio) of €23,696. The benefit of using Rituximab is cost-effectiveness with a QALY/gained under the acceptable threshold of €50,000 in our observational study. These are important data for discussion from the economic point of view when we choose a biologic therapy for rheumatoid arthritis in clinical practice.

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References

  1. Salaffi F, De Angelis R, Grassi W, MArche Pain Prevalence; Investigation Group (MAPPING) study (2005) Prevalence of musculoskeletal conditions in an Italian population sample: results of a regional community-based study. I. The MAPPING study. Clin Exp Rheumatol 23(6):819–828

    PubMed  CAS  Google Scholar 

  2. Leardini G, Salaffi F, Montanelli R, Gerzeli S, Canesi B (2002) A multicenter cost-of-illness study on rheumatoid arthritis in Italy. Clin Exp Rheumatol 20(4):505–515

    PubMed  CAS  Google Scholar 

  3. Kobelt G, Johnsson L, Lindgren P, Young A, Eberhardt K (2002) Modeling the progression of rheumatoid arthritis. A two-country model to estimate costs and consequences RA. Arthritis Rheum 46:2310–2319

    PubMed  Article  Google Scholar 

  4. Fries J, Spitz P, Kraines R, Holman H (1980) Measurement of patient outcome in arthritis. Arthritis Rheum 23:137–145

    PubMed  Article  CAS  Google Scholar 

  5. Torrance G (1986) Measurement of health state utilities for economic appraisal. A review. J Health Econ 5:1–30

    PubMed  Article  CAS  Google Scholar 

  6. Kobelt G, Eberhardt K, Geborek P (2004) TNF-inhibitors in the treatment of rheumatoid arthritis in clinical practice: costs and outcomes in a follow-up study of patients with RA treated with etanercept or infliximab in southern Sweden. Ann Rheum Dis 63:4–10

    PubMed  Article  CAS  Google Scholar 

  7. Cohen SB, Emery P, Greenwald MW et al (2006) Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy. Arthritis Rheum 54:2793–2806

    PubMed  Article  CAS  Google Scholar 

  8. 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

    PubMed  Article  CAS  Google Scholar 

  9. Benucci M, Li Gobbi F, Sabadini L, Saviola G, Baiardi P, Manfredi M (2009) The economic burden of biological therapy in rheumatoid arthritis in clinical practice. Cost-effectiveness analysis in Italian patients treated with sub-cutaneous anti-TNFα. Int J Immunopathol Pharmacol 4:1147–1152

    Google Scholar 

  10. Kielhorn A, Duncan P, Diamantoupoulos A, Gavin L (2008) UK cost-utility of rituximab in patients with rheumatoid arthritis that failed to respond adequately to a biologic disease modifying antirheumatic drug. Curr Med Res Opin 24:2639–2650

    PubMed  Article  CAS  Google Scholar 

  11. 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 Health Care 25:181–189

    PubMed  Article  Google Scholar 

  12. Launois R, Payet S, Saidenberg-Kermanac N, Francesconi C, Riou Franc L, Boissier MC (2008) Budget impact model of rituximab after failure of one or more TNFa inhibitor therapies in the treatment of rheumatoid arthritis. Joint Bone Spine 65:288–295

    Google Scholar 

  13. Benucci M, Iannazzo S, Zaniolo O, Sabadini L (2010) Rituximab in the treatment of rheumatoid arthritis patients in Italy: a budget impact analysis. Clin Exp Rheumatol (in press)

  14. Hallinen TA, Soini EJ, Eklund K, Puolakka K (2010) Cost-utility of different treatment strategies after the failure of tumor necrosis factor inhibitor in rheumatoid arthritis in the Finnish setting. Rheumatology 4:767–777

    Article  Google Scholar 

  15. Jacobsson L, Lindroth Y, Marsal L (2007) Rheumatoid arthritis: what does it cost and what factors are driving those costs? Results of survey in a community-derived population in Malmo, Sweden. Scand J Rheumatol 36:179–183

    PubMed  Article  CAS  Google Scholar 

  16. Keystone E (2006) Switching tumor necrosis factor inhibitors: an opinion. Nat Clin Pract Rheumatol 35:415–425

    Google Scholar 

  17. Van Vallenhoven R, Hariu H, Brennemark S, Klareskog L (2003) Treatment with infliximab when etanercept has failed or vice versa: data from the STURE registry showing that switching tumor necrosis factor alpha blockers can make sense. Ann Rheum Dis 62:1195–1198

    Article  Google Scholar 

  18. Finckh A, Ciurea A, Brulhart L (2007) B cells depletion may be more effective than switching to an alternative anti-tumor necrosis factor agent in rheumatoid arthritis patients with inadequate response to anti-tumor necrosis factor agents. Arthritis Rheum 56:1417–1423

    PubMed  Article  Google Scholar 

  19. Geborek P, Saxne T (2000) Clinical protocol for monitoring of targeted therapies in rheumatoid arthritis. Rheumatology 39:1159–1161

    PubMed  Article  CAS  Google Scholar 

  20. Karlson JA, Kristensen LE, Kapaetanovic MC (2008) Treatment response to a second or third TNF inhibitor in RA: results from South Swedish Arthritis Treatment Group Register. Rheumatology 47:507–513

    Article  Google Scholar 

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Author information

Affiliations

  1. Rheumatology Unit, Department of Internal Medicine, Ospedale di S. Giovanni di Dio, Azienda Sanitaria di Firenze, Via Torregalli 3, 50143, Florence, Italy

    Maurizio Benucci

  2. Rheumatology and Rehabilitation Unit, Salvatore Maugeri Foundation IRCCS, Mantua, Italy

    Gianantonio Saviola

  3. Methodology Unit, University of Pavia and Salvatore Maugeri Foundation IRCCS, Mantua, Italy

    Paola Baiardi

  4. Immunology and Allergology Laboratory Unit, Ospedale S. Giovanni di Dio, Azienda Sanitaria di Firenze, Florence, Italy

    Mariangela Manfredi

Authors
  1. Maurizio Benucci
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  2. Gianantonio Saviola
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  3. Paola Baiardi
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  4. Mariangela Manfredi
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Correspondence to Maurizio Benucci.

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Benucci, M., Saviola, G., Baiardi, P. et al. Cost-effectiveness treatment with Rituximab in patients with rheumatoid arthritis in real life. Rheumatol Int 31, 1465–1469 (2011). https://doi.org/10.1007/s00296-010-1502-6

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  • DOI: https://doi.org/10.1007/s00296-010-1502-6

Keywords

  • Cost-effectiveness
  • Rheumatoid arthritis
  • Rituximab