Cost-effectiveness analysis of baricitinib versus adalimumab for the treatment of moderate-to-severe rheumatoid arthritis in Spain

Max Schlueter, Elaine Finn, Silvia Díaz, Tatiana Dilla, José Inciarte-Mundo, Walid Fakhouri, Max Schlueter, Elaine Finn, Silvia Díaz, Tatiana Dilla, José Inciarte-Mundo, Walid Fakhouri

Abstract

Background: Baricitinib is an oral janus kinase inhibitor for the treatment of rheumatoid arthritis (RA) and is approved in Europe for use in adults with moderately-to-severely active RA and an inadequate response or intolerance to conventional synthetic disease-modifying antirheumatic drug (csDMARD) therapy. To date, no economic evaluations have assessed the cost-effectiveness of baricitinib in the Spanish setting. Objectives: To evaluate the cost-effectiveness of baricitinib versus adalimumab for the treatment of moderately-to-severely active RA in the Spanish setting. Methods: A discrete event simulation model was developed in Microsoft Excel. Costs and outcomes were estimated over a lifetime horizon using the Spanish national payer perspective. The model compared baricitinib 4 mg once daily in combination with methotrexate with adalimumab 40 mg every other week in combination with methotrexate. Effectiveness and physical function were captured using the American College of Rheumatology criteria and the Health Assessment Questionnaire-Disability Index, input values of which were derived from a phase 3, double-blind, placebo- and active-controlled trial (RA-BEAM; funded by Eli Lilly and Incyte; ClinicalTrials.gov number, NCT01710358). Costs are presented in Euros, 2018 values. Results: In the base case analysis, baricitinib was associated with a quality-adjusted life year gain of 0.09 years over a lifetime horizon, at an incremental cost of -€558 versus adalimumab. Results of various scenario analyses and probabilistic sensitivity analysis generally were consistent with the base case analysis. Conclusion: This analysis suggests that baricitinib is a cost-effective treatment option compared to adalimumab for Spanish patients with moderately-to-severely active RA and a previous inadequate response or intolerance to csDMARD therapy.

Keywords: JAK inhibitor; adalimumab; baricitinib; cost-effectiveness; rheumatoid arthritis.

Conflict of interest statement

Walid Fakhouri, José Inciarte-Mundo, Silvia Diaz and Tatiana Dilla are employees of Eli Lilly and hold Eli Lilly shares. Max Schlueter and Elaine Finn are full-time employees of IQVIA and acted as consultants for this study funded by Eli Lilly and Company. Dr Jose Inciarte reports personal fees from Eli Lilly and Company, during the conduct of the study. The authors report no other conflicts of interset in this work.

Figures

Figure 1
Figure 1
Schematic representation of the model structure. Abbreviations: ACR, American College of Rheumatology; HAQ, Health Assessment Questionnaire.
Figure 2
Figure 2
Cost–effectiveness plane and cost–effectiveness acceptability curve. Abbreviation: QALY, quality-adjusted life year.

References

    1. Andrade P, Sacristán JA, Rentero ML, Hammen V, Dilla T. The burden of rheumatoid arthritis in Spain. Health Econ Outcome Res Open Access. 2017;3(126):2. doi:10.4172/2471-268X.1000126
    1. Gibofsky A. Overview of epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis. Am J Manag Care. 2012;18(13 Suppl):S295–S302.
    1. Silman AJ, Pearson JE. Epidemiology and genetics of rheumatoid arthritis. Arthritis Res. 2002;4(Suppl 3):S265–S272. doi:10.1186/ar578
    1. CDC. Rheumatoid arthritis (RA); 2018. Available from: . Accessed May 2018.
    1. NRAS. The burden of rheumatoid arthritis across Europe: a socioeconomic survey (BRASS); 2017. Available from: . Accessed May 2018.
    1. Taylor PC, Keystone EC, van der Heijde D, et al. Baricitinib versus Placebo or adalimumab in rheumatoid arthritis. N Engl J Med. 2017;376(7):652–662. doi:10.1056/NEJMoa1608345
    1. Gomez Reino J, Loza E, Andreu JL, et al. [Consensus statement of the Spanish society of rheumatology on risk management of biologic therapy in rheumatic patients]. Reumatol Clin. 2011;7(5):284–298. doi:10.1016/j.reuma.2011.05.002
    1. Eli Lilly. Data on file: Report and critical review of published RA models; 2016.
    1. Karnon J, Stahl J, Brennan A, Caro JJ, Mar J, Moller J. Modeling using discrete event simulation: a report of the ISPOR-SMDM modeling good research practices task force-4. Value Health. 2012;15:821–827. doi:10.1016/j.jval.2012.04.013
    1. Stevenson M, Archer R, Tosh J, Simpson E, Everson-Hock E, Stevens J, et al. Adalimumab, etanercept, infliximab,certolizumab pegol, golimumab, tocilizumab and abatacept for the treatment of rheumatoid arthritis not previously treated with disease-modifying antirheumatic drugs and after the failure of conventional disease-modifying antirheumatic drugs only: systematic review and economic evaluation. Health Technol Assess 2016;20(35)
    1. BIOBADASER registry. Sociedad Espanola de Reumatologia; 2017.
    1. López Bastida J, Oliva J, Antoñanzas F, et al. Propuesta de guía para la evaluación económica aplicada a las tecnologías sanitarias. Gac Sanit. 2010;24:154–170. doi:10.1016/j.gaceta.2009.07.011
    1. World Health Organisation. Spanish life tables. Available from: . Accessed February 2016.
    1. Michaud K, Vera-Llonch M, Oster G. Mortality risk by functional status and health-related quality of life in patients with rheumatoid arthritis. J Rheumatol. 2012;39(1):54–59. doi:10.3899/jrheum.110491
    1. Dougados M, van der Heijde D, Chen Y, et al. Baricitinib in patients with inadequate response or intolerance to conventional synthetic DMARDs: results from the RA-BUILD study. Ann Rheum Dis. Epub ahead of print, 2 Nov 2016.
    1. Carlson J, Ogale S, Dejonckheere F, Sullivan SD. Economic evaluation of tocilizumab monotherapy compared to adalimumab monotherapy in the treatment of severe active rheumatoid arthritis Value in Health. 2015;18(2):173–179. doi:10.1016/j.jval.2014.10.013.
    1. Eli Lilly. Data on file: Patient HAQ trajectory beyond RA-BEAM study (RA-BEYOND); 2018.
    1. Norton S, Sacker A, Dixey J, Done J, Williams P, Young A. Trajectories of functional limitation in early rheumatoid arthritis and their association with mortality. Rheumatology (Oxford). 2013;52(11):2016–2024. doi:10.1093/rheumatology/ket253
    1. Malottki K, Barton P, Tsourapas A, et al. Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a tumour necrosis factor inhibitor: a systematic review and economic evaluation. [Review] Health Technol Assess. 2011;15(14):1–278. doi:10.3310/hta15140
    1. Hernandez AM, Wailoo AJ, Ara R. Tails from the peak district: adjusted limited dependent variable mixture models of EQ-5D questionnaire health state utility values. Value Health. 2012;15(3):550–561. doi:10.1016/j.jval.2011.12.014
    1. Gisbert R BM. Base de Datos de Costes Sanitarios eSalud. Barcelona: Oblikue Consulting, S.L.; 2017. Available from: . Accessed May 2018.
    1. Base de Datos de medicamentos del Consejo General de Farmacéuticos (Bot PLUS 2.0). Available from: . Accessed February 2018.
    1. Real Decreto-ley 8/2010, de 20 de Mayo, por el que se adoptan medidas extraordinarias para la reducción del déficit público. Boletín Oficial Del Estado.2010;126:45070 Available from: . Accessed May 2018.
    1. Instituto Nacional de Estadistica. Índice de Precios de Consumo. Medias anuales; 2016.
    1. Sacristán JA, Oliva J, Del Llano J, Prieto L, Pinto JL. ¿Qué es una tecnología sanitaria eficiente en España? Gac Sanit. 2002;16:334–343.
    1. González A, Ivanova Y, Zozaya N, Jiménez M, Hidalgo Á, eds. La introducción de los biosimilares en España. Estimación del ahorro para el Sistema Nacional de Salud. 1st ed. Madrid: Fundación Weber; 2017.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe