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The Cost-Effectiveness of Biologics for the Treatment of Rheumatoid Arthritis: A Systematic Review

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  • Jaana T Joensuu
  • Saara Huoponen
  • Kalle J Aaltonen
  • Yrjö T Konttinen
  • Dan Nordström
  • Marja Blom

Abstract

Background and Objectives: Economic evaluations provide information to aid the optimal utilization of limited healthcare resources. Costs of biologics for Rheumatoid arthritis (RA) are remarkably high, which makes these agents an important target for economic evaluations. This systematic review aims to identify existing studies examining the cost-effectiveness of biologics for RA, assess their quality and report their results systematically. Methods: A literature search covering Medline, Scopus, Cochrane library, ACP Journal club and Web of Science was performed in March 2013. The cost-utility analyses (CUAs) of one or more available biological drugs for the treatment of RA in adults were included. Two independent investigators systematically collected information and assessed the quality of the studies. To enable the comparison of the results, all costs were converted to 2013 euro. Results: Of the 4890 references found in the literature search, 41 CUAs were included in the current systematic review. While considering only direct costs, the incremental cost-effectiveness ratio (ICER) of the tumor necrosis factor inhibitors (TNFi) ranged from 39,000 to 1 273,000 €/quality adjusted life year (QALY) gained in comparison to conventional disease-modifying antirheumatic drugs (cDMARDs) in cDMARD naïve patients. Among patients with an insufficient response to cDMARDs, biologics were associated with ICERs ranging from 12,000 to 708,000 €/QALY. Rituximab was found to be the most cost-effective alternative compared to other biologics among the patients with an insufficient response to TNFi. Conclusions: When 35,000 €/QALY is considered as a threshold for the ICER, TNFis do not seem to be cost-effective among cDMARD naïve patients and patients with an insufficient response to cDMARDs. With thresholds of 50,000 to 100,000 €/QALY biologics might be cost-effective among patients with an inadequate response to cDMARDs. Standardization of multiattribute utility instruments and a validated standard conversion method for missing utility measures would enable better comparison between CUAs.

Suggested Citation

  • Jaana T Joensuu & Saara Huoponen & Kalle J Aaltonen & Yrjö T Konttinen & Dan Nordström & Marja Blom, 2015. "The Cost-Effectiveness of Biologics for the Treatment of Rheumatoid Arthritis: A Systematic Review," PLOS ONE, Public Library of Science, vol. 10(3), pages 1-27, March.
    • Handle: RePEc:plo:pone00:0119683
    DOI: 10.1371/journal.pone.0119683
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    References listed on IDEAS

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    1. J. Lundkvist & F. Kastäng & G. Kobelt, 2008. "The burden of rheumatoid arthritis and access to treatment: health burden and costs," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 8(2), pages 49-60, January.
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    4. Kalle J Aaltonen & Liisa M Virkki & Antti Malmivaara & Yrjö T Konttinen & Dan C Nordström & Marja Blom, 2012. "Systematic Review and Meta-Analysis of the Efficacy and Safety of Existing TNF Blocking Agents in Treatment of Rheumatoid Arthritis," PLOS ONE, Public Library of Science, vol. 7(1), pages 1-14, January.
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    1. Saara Huoponen & Kalle J Aaltonen & Jaana Viikinkoski & Jarno Rutanen & Heikki Relas & Kirsi Taimen & Kari Puolakka & Dan Nordström & Marja Blom, 2019. "Cost-effectiveness of abatacept, tocilizumab and TNF-inhibitors compared with rituximab as second-line biologic drug in rheumatoid arthritis," PLOS ONE, Public Library of Science, vol. 14(7), pages 1-14, July.

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