Triple Therapy Versus Biologic Therapy for Active Rheumatoid Arthritis: A Cost-Effectiveness Analysis

Area of Science:

• Rheumatology
• Health Economics
• Clinical Trial Analysis

Background:

• The RACAT trial demonstrated that triple therapy is noninferior to etanercept-methotrexate for active rheumatoid arthritis (RA).
• Understanding the comparative cost-effectiveness of these first-line strategies is crucial for clinical and economic decision-making.

Purpose of the Study:

• To determine the cost-effectiveness of initiating etanercept-methotrexate versus triple therapy as a first-line treatment for active rheumatoid arthritis (RA).

Main Methods:

• A within-trial analysis of 353 RACAT trial participants was conducted.
• A lifetime analysis using a decision analytic cohort model extrapolated costs and outcomes.
• Societal and Medicare perspectives were adopted for the economic evaluation.

Main Results:

• First-line etanercept-methotrexate yielded marginally more quality-adjusted life-years (QALYs) but incurred substantially higher drug costs compared to triple therapy.
• Incremental cost-effectiveness ratios (ICERs) for first-line etanercept-methotrexate were $2.7 million/QALY (24 weeks) and $0.98 million/QALY (48 weeks).
• Lifetime analysis indicated an ICER of $521,520 per QALY for first-line etanercept-methotrexate, with an incremental cost of $77,290 for 0.15 additional QALYs.

Conclusions:

• Initiating biologic therapy like etanercept-methotrexate before trying triple therapy increases costs with minimal incremental benefit for RA patients.
• From a long-term perspective, etanercept-methotrexate is unlikely to be cost-effective compared to initiating triple therapy first.