Pharmacoeconomic analysis of biological disease modifying antirheumatic drugs in patients with rheumatoid arthritis based on real-world data from the IORRA observational cohort study in Japan

Abstract

Objectives: To evaluate the cost-effectiveness of biological disease modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) in a real-world setting in Japan.

Methods: We used a state-transition model and parameters were determined from RA patients registered in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort study on 421 patients who had failed at least one DMARD and started either 1 of 4 bDMARDs (bDMARD group; adalimumab, etanercept, infliximab, and tocilizumab) or methotrexate (control group). bDMARD group was evaluated as two groups: sequence of any 1 of 4 bDMARDs with and without tocilizumab. The incremental cost-effectiveness ratios (ICERs) for bDMARD group were estimated using base-case analysis, probabilistic sensitivity analysis (PSA) and scenario sensitivity analyses.

Results: ICERs of bDMARD group with or without tocilizumab were $38,179 and $48,855, respectively. By PSA, these sequences had respective probabilities of 86.8% and 75.1% of falling below the assumed cost-effectiveness threshold of $50,000 in Japan. Scenario sensitivity analyses showed that the best population for initiating bDMARD was RA patients less than 50 years old with Japanese version of HAQ between 1.1 and 1.6 and using tocilizumab as the bDMARD.

Conclusion: bDMARDs were cost-effective for RA patients based on a real-world setting in Japan.

Keywords:

• Biological disease modifying antirheumatic drugs
• Cost-effectiveness
• Quality-adjusted life years
• Rheumatoid arthritis
• Tocilizumab

Acknowledgments

The authors thank all members of the Institute of Rheumatology at the Tokyo Women’s Medical University for successful management of the IORRA cohort. The authors also acknowledge Ayako Syoji, PhD, of Nomura Research institute for construction of the Markov model for simulation of real-world cost-effectiveness. All authors retained full control of the manuscript.

Funding

This study was funded by Chugai Pharmaceutical Co., Ltd.

Conflicts of interest

Eiichi Tanaka has received lecture fees or consulting fees from Abbvie, Eisai Pharmaceutical, Chugai Pharmaceutical, Bristol Myers Squibb, Astellas Pharmaceutical, Pfizer, Takeda Pharmaceutical, and Santen Pharmaceutical. Hisashi Yamanaka has received an honorarium from the speaker bureaus of AbbVie, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, Pfizer, Takeda, and Teijin Pharma, and has received research grants from AbbVie, Asahikasei Pharma, Astellas, Bristol-Myers-Squibb, Chugai, Daiichi-Sankyo, Eisai, GlaxoSmithKline, Janssen, Mitsubishi-Tanabe, MSD, Nippon Kayaku, Pfizer, Santen, Taisho-Toyama, Takeda, and Teijin Pharma. Shigeki Momohara has received honorariums from the speakers bureaus of Abbvie Japan, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, and Takeda Pharmaceuticals. The rest of the authors do not have any conflicts to declare.