Session Type: Abstract Submissions (ACR)
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).
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%.
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).
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.
Abbvie, BMS, Pfizer, MSD, Roche, UCB,
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/adding-an-initial-six-month-course-of-infliximab-to-an-active-combination-treatment-is-cost-saving-in-working-aged-early-rheumatoid-arthritis-patients/