Cost-effectiveness of tocilizumab, a humanized anti-interleukin-6 receptor monoclonal antibody, versus methotrexate in patients with rheumatoid arthritis using real-world data from the IORRA observational cohort study

Abstract

Objectives. To evaluate the cost-effectiveness of tocilizumab in patients with rheumatoid arthritis (RA) in a real-world setting in Japan.

Methods. The cost-effectiveness was determined using a Markov model-based probabilistic simulation. Data from RA patients registered in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort study between April 2007 and April 2011 were extracted using a pair-matching method: tocilizumab group (n = 104), patients who used at least 1 disease-modifying anti- rheumatic drug and in whom tocilizumab treatment was initiated; methotrexate group (n = 104), patients in whom methotrexate treatment was initiated for the first time or after an interruption of 6 or more months. Assuming a 6-month cycle length, health benefits and costs were measured over a lifetime and discounted at an annual rate of 3%.

Results. Compared with methotrexate treatment, lifetime costs and quality-adjusted life years (QALYs) for tocilizumab treatment were approximately 1.5- and 1.3-times higher, respectively. Incremental cost per QALY gained with tocilizumab was $49,359, which was below the assumed cost-effectiveness threshold of $50,000 per QALY. The probability of tocilizumab being cost- effective was 62.2%.

Conclusion. The simulation model using real-world data from Japan showed that tocilizumab (at a certain price) may improve treatment cost-effectiveness in patients with moderate-to-severe RA by enhancing quality-adjusted life expectancy.

Keywords:

• Cost-effectiveness
• Quality-adjusted life years
• Rheumatoid arthritis
• the Japanese version of the Health Assessment Questionnaire
• Tocilizumab

Authors’ contributions

E. Tanaka and H. Yamanaka were the main designers of the study who planned, performed the analyses, and prepared the initial draft of the manuscript. All authors have contributed to data collection and interpretation and have critically reviewed the manuscript. The final version of the manuscript was approved by all authors.

Acknowledgements

The authors thank all members of the Institute of Rheumatology at the Tokyo Women's Medical University for successful management of the IORRA cohort. Medical writing services were provided by Cactus Communications. The authors retained full control of the manuscript content.

Funding

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

Conflicts of interest

HY has received honorarium for the lecture from AbbVie, Chugai, Daiichi-Sankyo, Eisai, Mitsubishi-Tanabe, Pfizer, Takeda, and Teijin Pharma. HY 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. SM has received honorarium for the lecture from AbbVie Japan, Chugai Pharmaceutical, Eisai, Mitsubishi Tanabe Pharma, and Takeda Pharmaceutical. There are no other competing interests for the other authors.

Supplementary material available online

Supplementary Tables 1–2 and Figures 1–2.