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Sequences of biological treatments for patients with moderate-to-severe rheumatoid arthritis in the era of treat-to-target in China: a cost-effectiveness analysis

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Abstract

Background

Biologic disease-modifying antirheumatic drugs (bDMARDs) are recommended to be added in sequentially in the treatment of moderate-to-severe rheumatoid arthritis (RA). All these drugs, however, are substantially more expensive than conventional synthetic DMARDs throughout the world, including in China. The objective of this study is to evaluate the cost-effectiveness of treatment sequences of bDMARDs for patients with moderate-to-severe rheumatoid arthritis from the Chinese healthcare system perspective.

Methods

An individual patient simulation model was used to track the course of patients from first treatment through switches to further lines in a sequence. The comparator treatment sequence commenced with methotrexate, followed by non-biologic therapy. The intervention sequences were assumed to be the combinations of bDMARDs available, followed by non-biologic therapy. Life-years, quality-adjusted life-years (QALYs), and lifetime costs were estimated. Univariable and probabilistic sensitivity analyses and scenario analyses were performed to evaluate the model uncertainty.

Results

Compared with the comparator treatment sequence, bDMARDs sequences were associated with more life years, QALYs, and cost. These produced ICERs ranged from $27,441.36/QALY to $40,149.2/QALY, above the willingness-to-pay threshold of $10,378 per QALY. The uncertainty analyses and the scenario analyses confirmed the result of the base case analysis.

Conclusions

From the perspective of the Chinese healthcare system, bDMARDs sequences are estimated not to be cost-effective compared with conventional synthetic disease-modifying antirheumatic drug strategy for patients with moderate-to-severe RA at a WTP threshold of $10,378 per QALY. Price reductions are warranted to make bDMARDs cost-effective and affordable.

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Data Availability

All data generated or analyzed during this study are included in this published article and its supplementary information files.

Code availability

Coding is available on reasonable request.

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Funding

This work was supported by grants from the National Natural Science Foundation of China (No. 71874209) and Hunan Provincial Natural Science Foundation of China (No. 2019JJ40411). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Pharmacy, The Second Xiangya Hospital, Central South University, 139 Renmin Rd, Changsha, 410011, Hunan, China

    Chongqing Tan, Xia Luo, Lidan Yi, Liubao Peng, Shuxia Qin, Liting Wang & Xiaomin Wan

  2. Institute of Clinical Pharmacy, Central South University, Changsha, 410011, Hunan, China

    Chongqing Tan, Xia Luo, Lidan Yi, Liubao Peng, Shuxia Qin, Liting Wang & Xiaomin Wan

  3. The Xiangya Nursing School, Central South University, Changsha, 410013, Hunan, China

    Sini Li

  4. PET Imaging Center, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China

    Xiaohui Zeng

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  1. Chongqing Tan
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  2. Xia Luo
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  3. Sini Li
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  4. Lidan Yi
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  9. Xiaomin Wan
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Correspondence to Xiaomin Wan.

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Key points

From the perspective of the Chinese healthcare system, biologic disease-modifying antirheumatic drug sequences are estimated not to be cost-effective compared with conventional synthetic disease-modifying antirheumatic drug strategy for patients with moderate-to-severe rheumatoid arthritis. Price reductions are warranted to make the biologic agents cost-effective and affordable.

Tan Chongqing and Luo Xia contributed equally to this work.

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Tan, C., Luo, X., Li, S. et al. Sequences of biological treatments for patients with moderate-to-severe rheumatoid arthritis in the era of treat-to-target in China: a cost-effectiveness analysis. Clin Rheumatol 41, 63–73 (2022). https://doi.org/10.1007/s10067-021-05876-4

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