ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 2484

Adding an Initial Six-Month Course of Infliximab to an Active Combination Treatment Is Cost Saving in Working-Aged Early Rheumatoid Arthritis Patients

Vappu Rantalaiho1, Kari Puolakka2, Janne Martikainen3, Hannu Kautiainen4,5,6 and Marjatta Leirisalo-Repo7,8, 1Department of Internal Medicine, Centre for Rheumatic Diseases, Tampere University Hospital, Tampere, Finland, 2Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland, 3Pharmacoeconomics and Outcomes Research Unit, School of Pharmacy, University of Eastern Finland, Kuopio, Finland, 4Department of General Practice, University of Helsinki, Helsinki, Finland, 5Unit of Primary Health Care, Turku University Hospital, Turku, Finland, 6Unit of Primary Health Care, Helsinki University Central Hospital, Helsinki, Finland, 7Department of Clinical Medicine, University of Helsinki, Helsinki, Finland, 8Department of Medicine, Division of Rheumatology, Helsinki University Central Hospital, Helsinki, Finland

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords:

Session Information

Title: Rheumatoid Arthritis - Small Molecules, Biologics and Gene Therapy: Therapeutic Strategies, Biomarkers and Predictors of Outcomes in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose

To study the cost-effectiveness of adding initial infliximab to a remission-targeted combination treatment with disease modifying antirheumatic drugs (DMARDs) in early rheumatoid arthritis (RA).

Methods

Economic evaluation was conducted alongside the NEO-RACo trial with a 2-year follow-up. A total of 99 patients with early, DMARD-naïve RA, receiving a triple combination of DMARDs and prednisolone, were randomized to double-blindly receive either added-on infliximab (FIN-RACo+INFL) or placebo (FIN-RACo+PLA) infusions during the first 6 months. All the patients fulfilled the ACR 1987 classification criteria for RA, were 18 to 60 years of age, and available for the workforce.

Direct costs during the 2-year follow-up were estimated on a micro-costing level. The consumed resources were collected from the study forms including all RA-related visits, medications, intraarticular injections, physiotherapy, splints and aids, as well as another person’s help. The unit costs were obtained from the national list of health care costs and other public sources. In addition, data about the lost workdays due to RA were gathered, and the monetary value of lost productivity was estimated by the human capital method. The quality-adjusted life-years (QALYs) gained were calculated on the basis of SF-6D utilities. Both the costs and the QALYs were discounted by 3%.

Results

Over the 2-year follow-up, the average direct costs were 13,574 Euro for the patients in FIN-RACo+INFL group and 6,160 Euro for those in FIN-RACo+PLA group. In FIN-RACo+INFL the patients lost 51 workdays and in FIN-RACo+PLA 101 workdays. The respective lost productivity was 8,841 Euro and 17,387 Euro, while the total costs amounted 22,415 Euro and 23,548 Euro. In FIN-RACo+INFL group the patients gained on average 1.5533 QALYs and in FIN-RACo+PLA group 1.5267 QALYs with difference of 0.0266 (95% CI: – 0.065 to 0.1139, by bias-corrected and accelerated bootstrapping). Based on the direct costs only, the 2-year incremental cost-effectiveness ratio of adding an initial 6-month course of INFL on the FIN-RACo combination was 278,918 Euro. However, when taking also the indirect costs into account, the FIN-RACo-INFL treatment was a dominant option (i.e., less costly and more effective).

Conclusion

From the societal point of view, the induction treatment of early RA by adding a six-month course of infliximab on a targeted treatment with combination DMARDs and prednisolone is cost saving in working-aged patients.

Disclosure:

V. Rantalaiho,
None;

K. Puolakka,

Abbvie, BMS, Pfizer, MSD, Roche, UCB,

5;

J. Martikainen,
None;

H. Kautiainen,
None;

M. Leirisalo-Repo,

MSD, Pfizer,

5.

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