Cost–effectiveness of abatacept for moderate-to-severe rheumatoid arthritis

Abstract

Abatacept, a selective T-cell costimulation modulator, has become a valuable treatment option for those with moderately to severely active rheumatoid arthritis. Given new clinical evidence, for the first time guidelines from the American College of Rheumatology and Canadian Rheumatology Association are promoting the consideration of abatacept as the first biologic added to initial traditional disease-modifying antirheumatic drugs once an inadequate response to disease-modifying antirheumatic drug monotherapy has been established, putting abatacept at the same line of treatment options as TNF-α inhibitors or rituximab. Since the advent of the subcutaneous formulation of abatacept, positive results from its clinical trials have further increased its appeal. In light of these changes, a review of the literature was conducted on the cost–effectiveness of abatacept for moderate-to-severe rheumatoid arthritis. Here we discuss current evidence, gaps in the literature and abatacept's future outlook.

Keywords::

• abatacept
• biologic response modifiers
• cost–effectiveness
• health economics
• rheumatoid arthritis

Financial & competing interests disclosure

CA Marra was on the advisory board for BMS between year 2011 and 2012. K Shojania has received advisory board and speaker fees from BMS. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The comparator in currently published economic evaluations of abatacept in patients with inadequate response to traditional disease-modifying antirheumatic drugs has been methotrexate (MTX). As such, the result that abatacept is cost-effective for this patient population is relevant only in the context of comparing to a drug that most of the patients had already failed on. Some economic analyses of abatacept in patients who have had an inadequate response to TNF-α inhibitors still use MTX as the comparator and claim abatacept as more cost-effective than MTX in this patient population.

• Subcutaneous (sc.) abatacept (without intravenous [iv.] loading dose) was compared with sc. adalimumab in the AMPLE study, demonstrating noninferiority of abatacept. However, economic evaluations for sc. abatacept have yet to be conducted.

• Despite initial studies of sc. abatacept with iv. loading doses and this being its approved indication of use by most regulatory agencies, clinicians largely regard sc. abatacept as equivalent in efficacy and safety to its iv. formulation and are unlikely to be administering it with iv. loading dosing.

• Given the advent of sc. abatacept, its fixed dosing and convenient administration, economic evaluations to determine its economic impact is of great interest.

• Future research in moderate-to-severe rheumatoid arthritis, in particular head-to-head comparisons of biologic response modifiers and corresponding economic evaluations will be crucial in determining the place of abatacept in the RA treatment armamentarium.

Notes