Economic evaluation of low-dose SKA cytokines in patients with rheumatoid arthritis in maintaining low disease activity or remission

Valutazione economica delle citochine a basso dosaggio nel trattamento di mantenimento in pazienti con artrite reumatoide a bassa attività di malattia o in remissione.

  • Roberto Ravasio Department of Health Economics, Pharmes Srl, Milan, Italy
  • Alberto Migliore Operative Unit of Rheumatology “S. Pietro Fatebenefratelli” Hospital, Roma - Italia
Keywords: low-dose SKA cytokines, rheumatoid arthritis, Cost, maintenance, Italian NHS

Abstract

Introduction. The administration of low-dose SKA cytokines allows to maintain remission or low disease activity in patients with rheumatoid arthritis. This analysis aims to estimate the maintenance treatment cost of low-dose SKA cytokines versus DMARDs in patients with rheumatoid arthritis.

Methods and Results. Rather than evaluating the cost-effectiveness of individual therapeutic agents, it becomes recommendable for decision-makers to identify an optimal sequencing of such agents. A one-year cost consequence analysis (CCA) was conducted, comparing two alternative strategies to maintain remission or low disease activity in patients with rheumatoid arthritis: i) first line with low-dose SKA cytokines and second line with antitumor necrosis factor-α (TNF-α), ii) first line with DMARDs and second line with TNF-α. The CCA was conducted from the perspective of the Italian National Health Service (iNHS). Only direct medical costs (drugs cost) were considered. We performed a sensitivity analysis to test the robustness of the results. The sequence using cytokines in first line showed the lower mean annual cost of treatment: the mean annual cost per patient was €1,280.96 with cytokines and €1,987.21 with DMARDs. Sensitivity analyses confirmed the base case result.

Conclusion. From the iNHS’s perspective low-dose, SKA cytokines, as first line treatment appears a cost-saving strategy to maintain remission or low disease activity in patients with rheumatoid arthritis. (HTA & Market Access)

References

Gibofsky A. Epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis: A Synopsis. Am J Manag Care. 2014 May;20(7 Suppl):S128-35.

Gibofsky A. Overview of epidemiology, pathophysiology, and diagnosis of rheumatoid arthritis. Am J Manag Care. 2012 Dec;18(13 Suppl):S295-302.

Rossini M, Rossi E, Bernardi D et al. Prevalence and incidence of rheumatoid arthritis in Italy. Rheumatol Int. 2014;34:659-64. Doi: 10.1007/s00296-014-2974-6.

Nell VP, Machold KP, Ebrel G et al. Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology. 2004;43:906-14.

Emery P, Breedveld FC, Dougados M et al. Early referral recommendation for newly diagnosed rheumatoid arthritis: evidence-based development of a clinical guide. Ann Rheum Dis. 2002;61:290-7.

Kuek A, Hazleman BL, Östor AJK. Immune mediated inflammatory diseases (IMIDs) and biologic therapy: a medical revolution. Postgrad Med J. 2007;83:251-60.

Lee DM, Weinblatt ME. Rheumatoid arthritis. Lancet. 2001:358:903-11.

Caporali R, Conti F, Alivernini S et al. Recommendations for the use of biologic therapy in rheumatoid arthritis: update from the Italian Society for Rheumatology I. Efficacy. Clin Exp Rheumatol. 2011;29(Suppl. 66):S7-S14.

Thwaites C, Finney A. Rheumatoid arthritis. 2: Exploring treatment options to achieve early control and remission. Nurs Times. 2010;106(10):18-20.

National Institute for Health and Clinical Excellence. Rheumatoid arthritis (CG79): full guideline. London, UK: NICE; 2009. http://guidance.nice.org.uk/CG79/Guidance.

Strehblow C, Haberhauer G, Fasching P. Comparison of different biologic agents in patients with rheumatoid arthritis after failure of the first biologic therapy. Wien Med Wochenschr. 2010;160(9-10):225-9.

Burska A, Boissinot M, Ponchel F. Cytokines as biomarkers in rheumatoid arthritis. Mediators Inflamm. 2014;2014:545493.

Venkatesha SH, Dudics S, Acharya B, Moudgil KD. Cytokine-modulating strategies and newer cytokine targets for arthritis therapy. Int J Mol Sci. 2015;16(1):887-906.

Migliore A, Ballanti E, Laganà B et al. Biologic agents for rheumatoid arthritis: can we hypothesize new strategies of treatment? Med Hypotheses. 2014;82(1):117-21.

Martin-Martin LS, Giovannangeli F, Bizzi E et al. An open randomized active-controlled clinical trial with low-dose SKA cytokines versus DMARDs evaluating low disease activity maintenance in patients with rheumatoid arthritis. Drug Design, Development and Therapy. 2017;11:985-94.

Markusse IM, Dirven L, Gerards AH et al. Disease flares in rheumatoid arthritis are associated with joint damage progression and disability: 10-year results from the BeSt study. Arthritis Res Ther. 2015;17:232. https://doi.org/10.1186/s13075-015-0730-2

Russell LB, Gold MR, Siegel JE et al. The role of cost-effectiveness analysis in health and medicine. JAMA. 1996;276:1172-7.

Aletaha D, Neogi T, Silman AJ et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis. 2010;69(9):1580-8.

Adalimumab. Riassunto delle Caratteristiche del Prodotto. Accesso: Aprile 2020. https://www.ema.europa.eu/en/documents/product-information/humira-epar-product-information_it.pdf

Etanercept. Riassunto delle Caratteristiche del prodotto. Accesso: Aprile 2020. https://www.ema.europa.eu/en/documents/product-information/enbrel-epar-product-information_it.pdf

Infliximab. Riassunto delle Caratteristiche del Prodotto. Accesso: Aprile 2020. https://www.ema.europa.eu/en/documents/product-information/remicade-epar-product-information_it.pdf

Certolizumab. Riassunto delle Caratteristiche del Prodotto. Accesso: Aprile 2020. https://www.ema.europa.eu/en/documents/product-information/cimzia-epar-product-information_it.pdf

Golimumab. Riassunto delle Caratteristiche del Prodotto. Accesso: Aprile 2020. https://www.ema.europa.eu/en/documents/product-information/simponi-epar-product-information_it.pdf

Lista di trasparenza. Accesso: Aprile 2020. https://www.aifa.gov.it/pt/liste-di-trasparenza

Abatacept. Riassunto delle Caratteristiche del Prodotto. Accesso: Aprile 2020. https://www.ema.europa.eu/en/documents/product-information/orencia-epar-product-information_it.pdf

Tocilizumab. Riassunto delle Caratteristiche del Prodotto. Accesso: Aprile 2020. https://www.ema.europa.eu/en/documents/product-information/roactemra-epar-product-information_it.pdf

Published
2020-09-01
How to Cite
1.
Ravasio R, Migliore A. Economic evaluation of low-dose SKA cytokines in patients with rheumatoid arthritis in maintaining low disease activity or remission. AO [Internet]. 1Sep.2020 [cited 16May2021];7(1):67-3. Available from: https://journals.aboutscience.eu/index.php/aboutopen/article/view/2153
Section
Original research article