Session Information
Date: Monday, November 6, 2017
Session 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.
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 January 22, 2020.« Back to 2017 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/economic-evaluation-of-rituximab-versus-azathioprine-for-maintenance-treatment-of-anca-associated-vasculitis-a-prospective-multicenter-study/