Mean cost per number needed to treat with tocilizumab plus methotrexate versus abatacept plus methotrexate in the treatment of rheumatoid arthritis in patients previously treated with methotrexate

Figures & data

Table 1 ACR and EULAR criteria: TCZ + Mtx versus ABT + Mtx

Criteria	cDMARDs	ABT iv + Mtx	ABT sc + Mtx	TCZ iv + Mtx	TCZ sc + Mtx
ACR
ACR 20	28% (24%–32%)	56% (44%–66%)	58% (43%–72%)	64% (53%–73%)	64% (53%–73%)
ACR 50	12% (10%–14%)	32% (23%–43%)	34% (22%–50%)	40% (30%–51%)	40% (30%–51%)
ACR 70	4% (3%–5%)	15% (9%–22%)	16% (9%–23%)	20% (13%–29%)	20% (13%–29%)
EULAR
Moderate response	45% (38%–52%)	69% (36%–91%)	69% (36%–91%)	91% (74%–98%)	91% (74%–98%)
Good response	9% (6%–14%)	24% (6%–57%)	24% (6%–57%)	57% (28%–83%)	57% (28%–83%)

Note: Data from a previous study.²⁰

Abbreviations: ACR, American College of Rheumatology; EULAR, European League against Rheumatism; cDMARDs, conventional disease-modifying antirheumatic drugs; ABT, abatacept; Mtx, methotrexate; TCZ, tocilizumab; sc, subcutaneous; iv, intravenous.

Table 2 Mean 6-monthly cost of treatment with bDMARDs

bDMARDs	Dose	Pack	Price/pack	Monthly cost	6-monthly cost
Tocilizumab (iv)*	8 mg/kg every 4 weeks	1 vial, 4 mL, 20 mg/mL	€149.25	€1,131.77	€6,790.62
Tocilizumab (sc)	162 mg every week	4 syringes, 162 mg	€1,044.17	€1,131.19	€6,787.14
Abatacept (iv)*	750 mL every 4 weeks	3 vials, 250 mL	€1,077.30	€1,167.08	€7,002.48
Abatacept (sc)	125 mg every week	4 pens, 125 mg	€969.00	€1,049.75	€6,298.50

Note:

* Assumed mean patient weight is 70 kg.

Abbreviations: bDMARDs, biological disease-modifying antirheumatic drugs; iv,intravenous; sc, subcutaneous.

Table 3 Monitoring: mean 6-monthly cost

Health services	Unit cost	bDMARDs iv		bDMARDs sc
		6-month services	6-month cost	6-month services	6-month cost
Visit	€20.66	6	€123.96	2	€41.32
Complete blood count	€3.17	6	€19.02	2	€6.34
ESR and CRP	€5.82	6	€34.92	2	€11.64
Liver function	€2.04	6	€12.24	2	€4.08
Urea, electrolytes, and creatinine	€9.57	6	€57.42	2	€19.14
Chest X-ray	€15.49	1	€15.49	1	€15.49
Cholesterol	€2.47	3	€7.41	1	€2.47
Total (6 months)			€270.46		€100.48

Note: Data from a previous study.²⁸

Abbreviations: ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; bDMARDs, biological disease-modifying antirheumatic drugs; iv,intravenous; sc, subcutaneous.

Table 4 Number needed to treat

NNT vs cDMARDs	ABT iv + Mtx	ABT sc + Mtx	TCZ iv + Mtx	TCZ sc + Mtx
ACR criteria
ACR20	3.57	3.33	2.78	2.78
ACR50	5.00	4.55	3.57	3.57
ACR70	9.09	8.33	6.25	6.25
EULAR criteria
Moderate response	4.17	4.17	2.17	2.17
Good response	6.67	6.67	2.08	2.08

Abbreviations: NNT, number needed to treat; cDMARDs, conventional disease-modifying antirheumatic drugs; ACR, American College of Rheumatology; EULAR, European League against Rheumatism; ABT, abatacept; Mtx, methotrexate; TCZ, tocilizumab; sc, subcutaneous; iv, intravenous.

Table 5 Mean 6-monthly cost of treatment per patient

Cost	ABT iv + Mtx	ABT sc + Mtx	TCZ iv + Mtx	TCZ sc + Mtx
Administration	€69.72	€0.00	€69.72	€0.00
Monitoring	€270.46	€100.48	€270.46	€100.48
Medicinal product	€7,002.48	€6,298.50	€6,790.62	€6,787.14
Total	€7,342.66	€6,398.98	€7,130.80	€6,887.62

Abbreviations: ABT, abatacept; Mtx, methotrexate; TCZ, tocilizumab; sc, subcutaneous; iv, intravenous.

Figure 1 Mean cost per NNT: ACR criteria.

Abbreviations: NNT, number needed to treat; ACR, American College of Rheumatology; sc, subcutaneous; iv, intravenous; ABT, abatacept; Mtx, methotrexate; TCZ, tocilizumab.

Figure 2 Mean cost per NNT: EULAR criteria.

Abbreviations: NNT, number needed to treat; EULAR, European League against Rheumatism; sc, subcutaneous; iv, intravenous; ABT, abatacept; Mtx, methotrexate; TCZ, tocilizumab.

Table 6 Sensitivity analysis (efficacy data variation)

MC per NNT	ABT iv + Mtx	ABT sc + Mtx	TCZ iv + Mtx	TCZ sc + Mtx
ACR criteria
ACR20 lower limit	€36,713.30	€33,658.63	€24,601.26	€23,762.29
ACR20 upper limit	€21,587.42	€15,997.45	€17,399.15	€16,805.79
ACR50 lower limit	€56,465.06	€53,303.50	€23,745.56	€22,935.77
ACR50 upper limit	€25,332.18	€17,789.16	€19,253.16	€18,596.57
ACR70 lower limit	€122,402.14	€106,671.00	€71,308.00	€68,876.20
ACR70 upper limit	€43,174.84	€35,578.33	€29,735.44	€28,721.38
EULAR criteria
Moderate response lower limit	n/a	n/a	€19,823.62	€19,147.58
Moderate response upper limit	€18,797.21	€16,381.39	€15,473.84	€14,946.14
Good response lower limit	n/a	n/a	€32,445.14	€31,338.67
Good response upper limit	€17,108.40	€14,909.62	€10,339.66	€9,987.05

Note: Data from a previous study.²⁰

Abbreviations: NNT, number needed to treat; ACR, American College of Rheumatology; EULAR, European League against Rheumatism; ABT, abatacept; Mtx, methotrexate; TCZ, tocilizumab; sc, subcutaneous; iv, intravenous; n/a not assessed; MC, mean cost.

Table 7 Cost per NNT – comparison at 24 weeks of treatment

Treatment	ACR50		ACR70
	NNT	Cost per NNT (US$)	NNT	Cost per NNT (US$)
ABT 10 mg/kg + Mtx	5.08	$61.088	10.61	$127.562
TCZ 4 mg/kg + Mtx	4.87	$31.363	7.50	$48.320

Note: Data from a previous study.³⁰

Abbreviations: NNT, number needed to treat; ACR, American College of Rheumatology; ABT, abatacept; Mtx, methotrexate; TCZ, tocilizumab.

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