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Cost-Effectiveness Analysis of First-Line Treatment With Biologic Agents in Polyarticular Juvenile Idiopathic

Nadia J Luca1, Heather F Burnett2, Wendy J Ungar2

  • 1Alberta Children's Hospital and University of Calgary, Calgary, Alberta, Canada.

Arthritis Care & Research
|April 10, 2016
PubMed

Insights

First-line etanercept (ETN) with methotrexate (MTX) for polyarticular juvenile idiopathic arthritis (JIA) is more costly but may be cost-effective for severe cases. Further research on anti-tumor necrosis factor (anti-TNF) efficacy is needed.

Area of Science:

  • Rheumatology
  • Health Economics
  • Pharmacoeconomics

Background:

  • The optimal timing for initiating biologic agents like etanercept (ETN) in polyarticular juvenile idiopathic arthritis (JIA) remains unclear.
  • This study addresses the economic and clinical outcomes of early versus stepwise biologic therapy in JIA patients.

Purpose of the Study:

  • To compare the costs and quality-adjusted life years (QALYs) of using etanercept (ETN) as a first-line treatment versus a step-wise approach in polyarticular JIA.
  • To evaluate the economic attractiveness of different treatment strategies for JIA from a healthcare system perspective.

Main Methods:

  • A cohort state-transition model was developed to simulate 5-year outcomes for newly diagnosed JIA patients.
  • Two strategies were compared: methotrexate (MTX) plus ETN first-line (ETN-first) versus MTX monotherapy followed by ETN (ETN-second).
  • Direct costs and QALYs were calculated from the Canadian healthcare system's perspective, with a 3% annual discount rate.

Main Results:

  • The ETN-first strategy resulted in an incremental cost of $16,893 and an additional 0.19 QALYs, yielding an incremental cost-effectiveness ratio (ICER) of $88,815 per QALY gained.
  • Cost-effectiveness was sensitive to ETN costs, model time horizon, and first-line therapy efficacy estimates.
  • The cost per QALY for treating severe JIA patients was $33,960.

Conclusions:

  • While first-line ETN with MTX is more expensive than MTX monotherapy, it may be economically viable for patients with severe JIA.
  • Further research is warranted to clarify the efficacy of first-line anti-tumor necrosis factor (anti-TNF) agents in JIA management.
Abstract

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