Economic evaluation of tocilizumab combination in the treatment of moderate-to-severe rheumatoid arthritis in Italy

Figures & data

Figure 1.  Treatment sequences modeled.

Table 1.  Economic model parameters.

Patient characteristics4–6
Female, %	82
Mean weight, kg	72.82
Mean starting HAQ score	1.51
ACR response*, % of patients (2.5%–97.5% CrL)21
ACR20
Tocilizumab pooled DMARD-IR population (OPTION, TOWARD, LITHE)	65 (51–76)
TNF inhibitor (etanercept, adalimumab, infliximab)	63 (55–71)
Rituximab (TNF-IR)	46 (37–56)
Abatacept (TNF-IR)	43 (33–54)
ACR50
Tocilizumab pooled DMARD-IR population (OPTION, TOWARD, LITHE)	44 (29–58)
TNF inhibitor (etanercept, adalimumab, infliximab)	39 (31–48)
Rituximab (TNF-IR)	23 (14–36)
Abatacept (TNF-IR)	22 (12–39)
ACR70
Tocilizumab pooled DMARD-IR population (OPTION, TOWARD, LITHE)	29 (21–38)
TNF inhibitor (etanercept, adalimumab, infliximab)	16 (14–19)
Rituximab (TNF-IR)	14 (5–39)
Abatacept (TNF-IR)	8 (2–27)
HAQ score benefit for ACR response, mean (SD)4–6
No response	–0.1357 (0.017)
ACR20	–0.4427 (0.018)
ACR50	–0.6680 (0.026)
ACR70	–0.9230 (0.032)
HAQ score change during treatment (SE)7,24–26
Tocilizumab (every 180 days)	–0.01867 (0.00432)
Biologic treatments	0.0000
Palliative care (every 180 days)	0.0300
Withdrawal rate (every 180 days)	0.10

ACR, American College of Rheumatology; DMARD, disease-modifying anti-rheumatic drug; HAQ, Health Assessment Questionnaire; IR, inadequate response; LITHE, TociLIzumab Safety and THE Prevention of Structural Joint Damage; OPTION, TOcilizumab Pivotal Trial in Methotrexate Inadequate respONders; TNF, tumor necrosis factor; TOWARD, Tocilizumab in cOmbination With traditional DMARD therapy.

*ACR response is presented as overlapping percentages. For the economic model ACR response is transformed to non-overlapping to reflect mutually exclusive probabilities of response.

Figure 2.  Change in individual HAQ scores.

Figure 3.  Utility–HAQ score mapping models.

Table 2.  Treatment acquisition costs (hospital acquisition prices)31.

	Annual treatment cost	SmPC dosages
Tocilizumab + methotrexate	€11,520.78	8 mg/kg every 4 weeks
Abatacept + methotrexate	€12,527.22	750 mg infusion every 4 weeks
Adalimumab + methotrexate	€12,134.02	40 mg every 2 weeks
Etanercept + methotrexate	€12,469.13	50 mg weekly
Infliximab + methotrexate	€11,210.76	4 mg/kg every 7 weeks
Rituximab + methotrexate	€10,567.42	2 g every 6 months
Methotrexate	€20.78	7.5 mg weekly

SmPC, summary of product characteristics.

Table 3.  Treatment administration costs31–33.

	Nurse time (min/cycle)	Rheumatologist time (min/cycle)	Administration cost/cycle	Annual administration cost
Tocilizumab + methotrexate	6.66	15	€17.41	€208.92
Abatacept + methotrexate	3.33	15	€15.98	€207.74
Adalimumab + methotrexate	4.50	–	€1.94	€50.44
Etanercept + methotrexate	4.50	–	€1.94	€100.88
Infliximab + methotrexate	20	15	€23.15	€185.20
Rituximab + methotrexate	56.66	30	€53.46	€106.92

Table 4.  Annual direct medical costs per patient based on ACR functional class2.

Direct medical costs	ACR functional class
	I	II	III	IV
Diagnostic examination
Physical	€61.4	€79.0	€105.3	€114.6
Instrumental	€55.8	€88.8	€77.0	€73.3
Laboratory	€130.6	€162.6	€177.6	€206.5
Therapy
Physiotherapy	€43.4	€65.6	€89.8	€157.0
Hospitalization
Routine	€399.6	€751.7	€1466.7	€1968.5
Rehabilitation	€106.4	€94.0	€0.0	€0.0
Day	€60.9	€101.7	€59.4	€13.4
Other costs
Transportation	€113.1	€110.5	€247.8	€134.7
House help	€50.1	€222.0	€840.0	€1689.7
Auxiliary devices	€64.0	€160.0	€121.8	€236.4
Total	€1085.3	€1835.9	€3185.4	€4594.1

ACR, American College of Rheumatology.

Table 5.  HAQ score-related direct medical costs9,34.

ACR functional class	HAQ score	Direct medical costs
I	<0.25	€1085.3
I	0.25–0.50	€1085.3
I	0.50–0.75	€1085.3
II	0.75–1.00	€1835.9
II	1.00–1.25	€1835.9
II	1.25–1.50	€1835.9
III	1.50–1.75	€3185.4
III	1.75–2.00	€3185.4
III	2.00–2.25	€3185.4
IV	2.25–2.50	€4594.1
IV	2.50–2.75	€4594.1
IV	2.75–3.00	€4594.1

ACR, American College of Rheumatology; HAQ, Health Assessment Questionnaire.

Table 6.  Economic model results.

Figure 4.  Cost-effectiveness scatter plot.

Figure 5.  Cost-effectiveness acceptability curve.

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