Economic Evaluation of Rituximab Versus Azathioprine for Maintenance Treatment of ANCA-Associated Vasculitis. a Prospective, Multicenter Study

Annalisa Montante¹, Alicia Le Bras², Benjamin Terrier³, Pascal Cohen³, Xavier Puéchal⁴, Alexandre Karras⁵, Philippe Ravaud⁶, Loïc Guillevin⁷ and Isabelle Durand-Zaleski⁸, ¹UNITÉ DE RECHERCHE ECONOMIQUE, UNIVERSITE PARIS DESCARTES, PARIS, France, ²UNITE DE RECHERCHE ECONOMIQUE, UNIVERSITE PARIS DESCARTES, PARIS, France, ³Service de Médecine Interne, Hôpital Cochin, Centre de référence national pour les maladies systémiques autoimmunes rares d’Ile de France, DHU Authors, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France, Paris, France, ⁴Service de Médecine Interne, Centre de Référence Maladies Auto-Immunes et Auto-Inflammatoires Systémiques Rares, Hôpital Cochin, Paris, France, ⁵Nephrology, HEGP, Paris, France, ⁶Hôpital Hôtel Dieu, Paris, France, ⁷Internal medicine, Cochin University Hospital, paris, France, ⁸UNITE DE RECHERCHE ECONOMIQUE, UNIVERSITE DE PARIS-CRETEIL, PARIS, France

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: ANCA, azathioprine, Economics, rituximab and vasculitis

Session Information

Date: Monday, November 6, 2017

Title: Vasculitis Poster II: ANCA-Associated Vasculitis

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose:

Rituximab was proven to be superior to azathioprine as maintenance therapy for ANCA-associated vasculitides (AAVs) at month 28 of MAINRITSAN-1–trial follow-up. Because of rituximab’s high cost, we conducted ancillary cost-utility and cost-effectiveness analyses.

Methods:

The multicenter, prospective, open-label randomized–controlled MAINRITSAN-1 trial included 115 patients in France between 2008 and 2012. We collected all hospital healthcare resources used: hospitalizations, consultations, drugs, tests. The costs of AAV-related inpatient and outpatient care were based on hospital codes. Quality of life was evaluated with the Medial Outcomes Study Short Form-36 questionnaire.

We calculated the incremental cost-utility (ICUR) and cost-effectiveness ratios (ICER) and their corresponding acceptability curves. Costs were assessed from the perspective of the French National Health Insurance, using 2016 reimbursement tariffs, expressed in euros. Deterministic sensitivity analyses assessed uncertainty over side effects and rituximab cost. Costs drivers were tested with a generalized linear model.

Results: Out of 115 patients enrolled in the trial, 3 were excluded from the economic study. The Table reports resource use and costs at trial month 28. Rituximab’s higher cost was partly offset by fewer relapses, side effects and follow-up expenses. The 28-month ICER was €13,092 per relapse avoided and the 28-month ICUR was €57,127/QALY. Relapses, side effects and renal impairment were major cost determinants.

	Azathioprine				Rituximab
		Mean(SD)	Median[IQR]	Mean(SD)		Median[IQR]
Inpatient stays, n		1.9(2.6)	1[0–2]	1.7(2.9)		1[0–2]
Length of stay (days)		14.1(24.1)	7[1–16]	12.1(13.6)		7[5–14]
Outpatient visits, n		3.5(4.9)	1[0–5]	6.3(2.8)		6[5–7]
Cost (€/patient)
Protocol drug		313(130)	337[(264–391]	6,035(165)		6,057[6,057–6,057]
Its administration		0	0[0–0]	2,467(1,076)		2,020[1,830–2,875]
Maintenance therapy		633(1,808)	0[0–0]	0(0)		0[0–0]
Relapses		2,547(4,748)	0[0–4,737]	724(3,537)		0[0–0]
Side effects		2,869(6,946)	0[0–2,523]	1,983(4,908)		0[0–2,531]
Follow-up		3,126(7,183)	636[0–3,254]	1,713(3,809)		0[0–2,426]
Outpatient visits		988(407)	1,069[770–1,314]	748(285)		615[614–669]
Total cost		10,476(10,558)	6,049[2,140–14,501]	13,617(7,946)		10,942[9,103–14,197]

Conclusion: Rituximab maintenance therapy is cost-effective to prevent AAV relapses.

Disclosure: A. Montante, None; A. Le Bras, None; B. Terrier, None; P. Cohen, None; X. Puéchal, None; A. Karras, None; P. Ravaud, None; L. Guillevin, None; I. Durand-Zaleski, None.

To cite this abstract in AMA style:

Montante A, Le Bras A, Terrier B, Cohen P, Puéchal X, Karras A, Ravaud P, Guillevin L, Durand-Zaleski I. Economic Evaluation of Rituximab Versus Azathioprine for Maintenance Treatment of ANCA-Associated Vasculitis. a Prospective, Multicenter Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/economic-evaluation-of-rituximab-versus-azathioprine-for-maintenance-treatment-of-anca-associated-vasculitis-a-prospective-multicenter-study/. Accessed .

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