Cost-utility analysis of the anti-TNF therapy for rheumatoid arthritis in a real-world based model

ABSTRACT

Background

Spending on drugs provided by the Brazilian Public Health System (BPHS) for the treatment of rheumatoid arthritis (RA) increased substantially with the beginning of the supply of biological disease-modifying anti-rheumatic drugs (bDMARD). This study aims to perform a cost-utility analysis of the most used biological drugs for the treatment of RA in Brazil.

Methods

a Markov model was used to carry out the cost-utility analysis. The data were obtained from a prospective cohort of RA patients using adalimumab, etanercept, and golimumab in Brazil. The BPHS perspective was adopted and the time horizon was five years. Deterministic and probabilistic sensitivity analyses were performed to evaluate the uncertainty.

Results

golimumab was the most cost-effective drug. Etanercept was dominated by golimumab. Adalimumab presented an incremental cost-utility ratio (ICUR) of $95,095.37 compared to golimumab in five years of follow-up. These results were confirmed by sensitivity analyses.

Conclusion

the utility among adalimumab, etanercept, and golimumab was similar and the cost was the component that most impacted the economic model. Therefore, depending on the agreed price with the drug manufacturers, the incremental cost-utility ratio may vary among them.

KEYWORDS:

• Adalimumab
• cost-utility analysis
• etanercept
• golimumab
• rheumatoid arthritis

Acknowledgments

JBR dos Santos and MRR da Silva thank the Coordination of Improvement of Higher Education Personnel for granting post-doctorate scholarships.

Author contributions

JBR Dos Santos was involved in the conception, design, analysis, and interpretation of the data, the drafting of the paper and revising it critically for intellectual content; MRR Da Silva was involved in the conception, design, analysis, and interpretation of the data, and revising it critically for intellectual content. AM Almeida, J Alvares-Teodoro, and FA Acurcio were involved in the conception, design, and revising it critically for intellectual content. All authors agreed to be accountable for all aspects of the work.

Reviewers disclosure

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Declaration of interest

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.

Additional information

Funding

This work was supported by the National Council for Scientific and Technological Development - CNPq [grant number: 471819/2013-1] and the Minas Gerais Research Funding Foundation - FAPEMIG [grant numbers: PPM-0015-15, 03799-16]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.