Mixed Treatment Comparison and Bayesian Integrated Economic Evaluation of Cost-Effectiveness and Budget Impact of TNF-alpha inhibitors for Rheumatoid Arthritis after Failure of Conventional DMARD Therapy

Abstract

Background: eighteen percent of patients with rheumatoid arthritis (Ra) do not respond adequately to conventional treatment with Methotrexate, upon which biological agents known as TnF-α inhibitors may be used. Objectives: our objective was three-fold: first, to assess the efficacy and safety of second line biotherapies on a patient population presenting moderate to severe Ra and who were unsuccessfully treated with conventional DMaRDs, second, to evaluate the cost-effectiveness of different Ra therapeutic strategies, and third, to estimate the budget impact of Ra management in France. Method: We conducted a systematic review of randomized control trials, conducted between 1999 and 2010, targeting Ra patients undergoing treatment with a biological agent, as well as a quantitative synthesis using a mixed treatment comparison approach. a Markov model was built to reproduce Ra patients’ care trajectories within the French healthcare system. Data on resource consumption were collected from an observational study and used to as model parameters in order to assess the cost-effectiveness and budget impact of biotherapies available in France. Results: our analysis revealed significant differences between biotherapies and DMaRDs, in terms of aCR50 response. When considering a willingness-to-pay (WTP) of €1,715, adalimumab was the most efficient treatment within, and etanercept the most effective beyond this threshold. The Budget impact analysis (Bia) showed that a decision to replace etanercept with more expensive and less effective therapies could result in a €28 million loss over 5 years. Conclusion: as cost-effective second-line treatments in Ra management, adalimumab and etanercept should constitute the preferred therapeutic options in France.