Sarilumab monotherapy compared with adalimumab monotherapy for the treatment of moderately to severely active rheumatoid arthritis: an analysis of incremental cost per effectively treated patient

Figures & data

Table 1 Demographics/characteristics of MONARCH sarilumab and adalimumab patient populations (base case analysis) and MOBILITY aggregate patient population (individual patient simulation)

Demographics/characteristics	MONARCH
	Sarilumab SC 200 mg Q2W (n=184)	Adalimumab SC 40 mg Q2W/QW (n=185)
Age, years, mean ± SD	50.9±12.6	53.6±11.9
Female, n (%)	157 (85.3)	150 (81.1)
Race, White–Caucasian, n (%)	171 (92.9)	164 (88.6)
Baseline HAQ-DI, mean ± SD	1.6±0.6	1.6±0.6
Baseline DAS28-ESR, mean ± SD	6.8±0.8	6.8±0.8
Duration of RA, years, mean ± SD	8.1±8.1	6.6±7.8
	MOBILITY
Age, years, mean (range) ± SD	50.6 (18–75)±11.6
Female, n (%)	977 (81.6)
Race, White–Caucasian, n (%)	1,031 (86.1)
Baseline HAQ-DI, mean (range) ± SD	1.6 (0.0–3.0)±0.6
Duration of RA, years, mean (range) ± SD	9.0 (0.3–44.7)±7.9

Abbreviations: DAS28-ESR, Disease Activity Score 28-joint count erythrocyte sedimentation rate; HAQ-DI, Health Assessment Questionnaire-Disability Index; Q2W, every 2 weeks; QW, once weekly; RA, rheumatoid arthritis; SC, subcutaneous.

Table 2 Treatment response rates applied to short-term and long-term models

Treatment	Treatment response based on:
	ACR20	ACR50	ACR70	EULAR DAS28-ESR Good/Moderate
Comparators
Sarilumab 200 mg SC Q2W – response ratesa	71.7%	45.7%	23.4%	84.2%
Adalimumab 40 mg SC Q2W – response ratesa	58.4%	29.7%	11.9%	70.9%
Etanercept 25 mg SC bid QW – response ratesb
OR sarilumab vs etanercept	1.01	0.94	0.47	–
Derived response rates	71.5%	47.2%	39.4%	–
Tofacitinib 5 mg bid oral – response ratesb
OR sarilumab vs tofacitinib	3.11	2.42	5.1	–
Derived response rates	44.9%	25.8%	5.7%	–

Notes:

a Data from Burmester et al.¹⁷

b Based on a network meta-analysis of targeted DMARD monotherapies for the treatment of rheumatoid arthritis.

Abbreviations: ACR, American College of Rheumatology; bid, twice daily; DAS28-ESR, Disease Activity Score 28-joint count erythrocyte sedimentation rate; DMARD, disease-modifying antirheumatic agent; EULAR, European League against Rheumatism; Q2W, every 2 weeks; QW, once weekly; SC, subcutaneous.

Figure 1 Model structure for long-term analysis.

Abbreviations: AE, adverse event; csDMARD, conventional synthetic disease-modifying antirheumatic drug; csDMARD-IR, inappropriate response or intolerance to csDMARDs/methotrexate; HAQ-DI, Health Assessment Questionnaire Disability Index; QALY, quality-adjusted life-year.

Table 3 Drug costs

6-Monthly drug costs (US$)a
Drug	Dose	6-Monthly induction costs	6-Monthly maintenance costs
Sarilumab	200 mg SC Q2W	$20,604	$20,604
Adalimumab	40 mg SC Q2W	$31,777	$31,777
Etanercept	50 mg SC QW	$31,777	$31,777
Tofacitinib	5 mg oral bid	$24,932	$24,932
csDMARD palliative treatmentb	N/A	N/A	$3,820

Notes:

a Based on wholesale acquisition costs (February 18, 2018). Long-term CE analysis considered 6 months cycle length of 26.08 weeks (=365.25/7); short-term CE analysis considered 24 weeks trial duration (over 52 yearly number of weeks), making treatment costs equal $18,954 and $29,232 for sarilumab and adalimumab, respectively, in this first analysis rather than the figures given in the table.

b Based on the following distribution of patients: 12.5% on methotrexate tablet alone, 12.5% on methotrexate syringe alone, 10% on prednisolone alone, 35% on methotrexate + prednisolone, 5% on sulfasalazine, 5% on leflunomide, 5% on hydroxychloroquine, and 15% on no treatment.³⁰

Abbreviations: bid, twice daily; csDMARD, conventional synthetic disease-modifying antirheumatic drug; N/A, not applicable; Q2W, every 2 weeks; QW, once weekly; SC, subcutaneous.

Figure 2 Responders (%) and NNT.

Abbreviations: ACR, American College of Rheumatology; EULAR, European League Against Rheumatism; NNT, number needed-to-treat; Q2W, every 2 weeks; QW, once weekly; SC, subcutaneous.

Figure 3 Cost per responder at 24 weeks: (A) base case analysis and (B) sensitivity analyses.

Abbreviations: ACR, American College of Rheumatology; EULAR, European League Against Rheumatism; Q2W, every 2 weeks; QW, once weekly; SC, subcutaneous.

Figure 4 Long-term incremental analyses.

Abbreviations: BCS, best care/palliative treatment; ETA, etanercept; TOF, tofacitinib; QALY, quality-adjusted life-year; Y, year.

Table 4 Long-term analyses: costs

Treatment sequence	Time horizon (years)	Sarilumab costs (US$)			Adalimumab costs (US$)			Incremental total costs: sarilumab vs adalimumab
		Drug	Routine	Total	Drug	Routine	Total
Next line: csDMARD palliative treatment	1	$33,056	$4,039	$37,095	$47,378	$4,150	$51,527	−$14,432
	5	$95,039	$19,278	$114,317	$122,202	$19,837	$142,039	−$27,722
	10	$140,728	$36,248	$176,977	$175,063	$37,073	$212,136	−$35,159
Next lines: tofacitinib > csDMARD palliative treatment	5	$133,457	$18,850	$152,307	$163,474	$19,370	$182,844	−$30,537
	10	$195,620	$35,776	$231,396	$232,544	$36,568	$269,112	−$37,716
Next lines: etanercept > csDMARD palliative treatment	5	$165,186	$18,384	$183,570	$198,083	$18,849	$216,931	−$33,362
	10	$247,966	$34,880	$282,847	$288,019	$35,603	$323,621	−$40,774
Next lines: etanercept > tofacitinib > csDMARD palliative treatment	5	$188,847	$18,122	$206,969	$223,368	$18,578	$241,946	−$34,977
	10	$288,454	$34,471	$322,925	$330,455	$35,186	$365,640	−$42,716

Abbreviation: csDMARD, conventional synthetic disease-modifying antirheumatic drug.

Table 5 Long-term analyses: outcomes

Treatment sequence	Time horizon (years)	Sarilumab outcomes			Adalimumab outcomes			Incremental QALYs: sarilumab vs adalimumab
		Time on treatment 1	LYs	QALYs	Time on treatment 1	LYs	QALYs
Next line: csDMARD palliative treatment	1	0.77	0.96	0.38	0.72	0.96	0.37	0.02
	5	1.93	4.38	1.69	1.66	4.38	1.60	0.09
	10	2.66	7.79	2.75	2.26	7.77	2.61	0.14
Next lines: tofacitinib > csDMARD palliative treatment	5	1.93	4.39	1.82	1.66	4.38	1.75	0.08
	10	2.66	7.81	3.01	2.26	7.80	2.89	0.12
Next lines: etanercept > csDMARD palliative treatment	5	1.93	4.39	1.95	1.66	4.39	1.89	0.06
	10	2.66	7.84	3.25	2.26	7.83	3.15	0.11
Next lines: etanercept > tofacitinib > csDMARD palliative treatment	5	1.93	4.40	2.02	1.66	4.40	1.97	0.06
	10	2.66	7.86	3.44	2.26	7.85	3.34	0.10

Abbreviation: csDMARD, conventional synthetic disease-modifying antirheumatic drug.

BurmesterGRLinYPatelREfficacy and safety of sarilumab monotherapy versus adalimumab monotherapy for the treatment of patients with active rheumatoid arthritis (MONARCH): a randomised, double-blind, parallel-group phase III trialAnn Rheum Dis201776584084727856432

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