TY - JOUR
T1 - Cost-effectiveness of abatacept, rituximab, and TNFi treatment after previous failure with TNFi treatment in rheumatoid arthritis
T2 - a pragmatic multi-centre randomised trial
AU - Manders, Sofie H.M.
AU - Kievit, Wietske
AU - Adang, Eddy
AU - Brus, Herman L.
AU - Bernelot Moens, Hein J.
AU - Hartkamp, Andre
AU - Hendriks, Lidy
AU - Brouwer, Elisabeth
AU - Visser, Henk
AU - Vonkeman, Harald E.
AU - Hendrikx, Jos
AU - Jansen, Tim L.
AU - Westhovens, Rene
AU - van de Laar, Mart A.F.J.
AU - van Riel, Piet L.C.M.
N1 - Funding Information:
We thank Sanne Rongen-van Dartel for management of the patient inclusion and randomisation processes. We acknowledge all research nurses and rheumatologists of the nine departments of rheumatology from the Netherlands and Belgium in the study for their participation in the data collection, and we acknowledge Erik Brummelkamp, Thea van Gaalen, Lia Schalkwijk, and Marion de Lange-Brandt for data processing and management. This work was supported by Netherlands Organisation for Health Research and Development (ZonMw) grant number 170995001. No one except the authors was involved in the study design, the analysis and interpretation of the results or the writing of the manuscript.
Funding Information:
TLJ is a member of the advisory boards of AbbVie, Ardea Biosciences, AstraZeneca, Bristol-Myers Squibb, Janssen Pharmaceutica, Menarini, Novartis, Pfizer, Roche Diagnostics and UCB and has received grant support for the present study from AbbVie and UCB. RW has received honoraria for KU Leuven for advice or public speaking from Bristol-Myers Squibb. JH has received a grant and honoraria for advice and speaking (both related to another project (i-control)). EB has received grant support from AbbVie (Abbott), Pfizer and Merck (formerly Schering-Plough/MSD). PLCMvR has received consulting honoraria from Abbott, Bristol-Myers Squibb, MSD Pharmaceuticals, Pfizer and Roche; speaking honoraria from Abbott, Bristol-Myers Squibb, Pfizer and Roche; and grants from Abbott, Bristol-Myers Squibb, MSD Pharmaceuticals and Roche. The other authors declare that they have no competing interests.
Publisher Copyright:
© 2015 Manders et al.; licensee BioMed Central.
PY - 2015/5/22
Y1 - 2015/5/22
N2 - Introduction: For patients with rheumatoid arthritis (RA) whose treatment with a tumour necrosis factor inhibitor (TNFi) is failing, several biological treatment options are available. Often, another TNFi or a biological with another mode of action is prescribed. The objective of this study was to compare the effectiveness and cost-effectiveness of three biologic treatments with different modes of action in patients with RA whose TNFi therapy is failing.Methods: We conducted a pragmatic, 1-year randomised trial in a multicentre setting. Patients with active RA despite previous TNFi treatment were randomised to receive abatacept, rituximab or a different TNFi. The primary outcome (Disease Activity Score in 28 joints) and the secondary outcomes (Health Assessment Questionnaire Disability Index and 36-item Short Form Health Survey scores) were analysed using linear mixed models. Cost-effectiveness was analysed on the basis of incremental net monetary benefit, which was based on quality-adjusted life-years (calculated using EQ-5D scores), and all medication expenditures consumed in 1 year. All analyses were also corrected for possible confounders.Results: Of 144 randomised patients, 5 were excluded and 139 started taking abatacept (43 patients), rituximab (46 patients) or a different TNFi (50 patients). There were no significant differences between the three groups with respect to multiple measures of RA outcomes. However, our analysis revealed that rituximab therapy is significantly more cost-effective than both abatacept and TNFi over a willingness-to-pay range of 0 to 80,000 euros.Conclusions: All three treatment options were similarly effective; however, when costs were factored into the treatment decision, rituximab was the best option available to patients whose first TNFi treatment failed. However, generalization of these costs to other countries should be undertaken carefully.Trial registration: Netherlands Trial Register number NTR1605. Registered 24 December 2008.
AB - Introduction: For patients with rheumatoid arthritis (RA) whose treatment with a tumour necrosis factor inhibitor (TNFi) is failing, several biological treatment options are available. Often, another TNFi or a biological with another mode of action is prescribed. The objective of this study was to compare the effectiveness and cost-effectiveness of three biologic treatments with different modes of action in patients with RA whose TNFi therapy is failing.Methods: We conducted a pragmatic, 1-year randomised trial in a multicentre setting. Patients with active RA despite previous TNFi treatment were randomised to receive abatacept, rituximab or a different TNFi. The primary outcome (Disease Activity Score in 28 joints) and the secondary outcomes (Health Assessment Questionnaire Disability Index and 36-item Short Form Health Survey scores) were analysed using linear mixed models. Cost-effectiveness was analysed on the basis of incremental net monetary benefit, which was based on quality-adjusted life-years (calculated using EQ-5D scores), and all medication expenditures consumed in 1 year. All analyses were also corrected for possible confounders.Results: Of 144 randomised patients, 5 were excluded and 139 started taking abatacept (43 patients), rituximab (46 patients) or a different TNFi (50 patients). There were no significant differences between the three groups with respect to multiple measures of RA outcomes. However, our analysis revealed that rituximab therapy is significantly more cost-effective than both abatacept and TNFi over a willingness-to-pay range of 0 to 80,000 euros.Conclusions: All three treatment options were similarly effective; however, when costs were factored into the treatment decision, rituximab was the best option available to patients whose first TNFi treatment failed. However, generalization of these costs to other countries should be undertaken carefully.Trial registration: Netherlands Trial Register number NTR1605. Registered 24 December 2008.
UR - http://www.scopus.com/inward/record.url?scp=84929414384&partnerID=8YFLogxK
U2 - 10.1186/s13075-015-0630-5
DO - 10.1186/s13075-015-0630-5
M3 - Article
C2 - 25997746
AN - SCOPUS:84929414384
SN - 1478-6354
VL - 17
JO - Arthritis Research and Therapy
JF - Arthritis Research and Therapy
IS - 1
M1 - 134
ER -
