Early treatment with a biosimilar agent increased total costs by £70 (US $89) per patient versus standard intervention.
In patients with rheumatoid arthritis (RA), early treatment with biologics can have substantial benefits; anti—tumor necrosis factor (anti-TNF) therapies, for example, increase the likelihood of remission and slow radiographic progression. The cost of biologics, however, means that many patients lack access to these agents.
In a newly published paper, a team of authors sought to assess the cost-effectiveness of early treatment with biologics—either reference or biosimilar—in patients who do not respond adequately to conventional drugs.
Using a Markov model to estimate lifetime patient costs, the researchers compared standard intervention (adding an anti-TNF agent to methotrexate after 12 months) with 2 early intervention options (adding an anti-TNF reference at 6 months or adding an anti-TNF biosimilar at 6 months).
Adding a reference anti-TNF agent after 6 month of methotrexate increased costs by £4701 (US $5978) per patient versus the standard intervention but decreased lifetime direct costs (such as medical costs) and indirect costs (such as loss of work productivity) by £3008 (US $3826) per patient. Overall, this intervention yielded a net cost increase of £1692 (US $2151) per patient.
Adding a biosimilar anti-TNF agent resulted in the same changes in lifetime direct and indirect costs, but resulted in a lower increase in treatment cost at £3078 (US $3914) per patient. Compared with standard intervention, total costs were increased in this scenario by £70 (US $89) per patient.
There was an increase of 0.10 quality-adjusted life years (QALYs) in patients who received early treatment, from 5.4 QALYs for the standard intervention to 5.5 QALYs for early therapy.
Early intervention versus standard intervention was shown to be cost-effective at a threshold of £30,000 (US $38,147) per QALY, with incremental cost-effectiveness ratios (ICERs) of £17,335 (US $22,042) per QALY for reference anti-TNF agents and £713 (US $907) per QALY with biosimilars.
While additional research is warranted, say the authors, this analysis is an important first step in research on early biologic therapy for patients with RA, and suggest that early biologic or biosimilar intervention is cost-effective and carries very low ICERs.
Patel D, Shelbaya A, Cheung R, Aggarwal J, Park SH, Coindreau J. Cost-effectiveness of early treatment with originator biologics or their biosimilars after methotrexate failure in patients with established rheumatoid arthritis [published online May 30, 2019]. Adv Ther. doi: 10.1007/s12325-019-00986-7.