Cost-Effectiveness of Early Treatment with Originator Biologics or Their Biosimilars After Methotrexate Failure in...

Area of Science:

• Rheumatology
• Health Economics
• Pharmacoeconomics

Background:

• Early aggressive biologic treatment benefits rheumatoid arthritis (RA) patients with inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).
• The cost-effectiveness of early intervention with originator biologics (e.g., tumor necrosis factor inhibitors [TNFis]) or their biosimilars in RA is not well-established.

Purpose of the Study:

• To evaluate the cost-effectiveness of early intervention strategies versus standard care for rheumatoid arthritis (RA) patients unresponsive to methotrexate (MTX).
• To compare early addition of originator biologic TNFis versus biosimilar TNFis to MTX monotherapy against standard care.

Main Methods:

• A Markov model was developed to estimate lifetime costs and utilities for RA patients with inadequate response to MTX.
• Cost-effectiveness analysis compared standard intervention (originator biologic TNFi at 12 months) with two early intervention pathways (originator or biosimilar TNFi at 6 months).

Main Results:

• Early intervention with originator biologic TNFis at 6 months increased costs by £1692 and utilities by 0.10 QALYs, with an ICER of £17,335/QALY.
• Early intervention with biosimilar TNFis at 6 months increased costs by £70 and utilities by 0.10 QALYs, with an ICER of £713/QALY.
• Both early originator and biosimilar TNFi interventions were cost-effective compared to standard care at a £30,000/QALY threshold.

Conclusions:

• Switching to combination therapy with originator or biosimilar TNFis at 6 months post-csDMARD failure in RA is cost-effective.
• Early intervention with biosimilar TNFis demonstrates a highly favorable ICER, suggesting significant value for RA management.