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Kumar S, Bagepally BS. Cost-effectiveness of tumor necrosis factor-alpha inhibitors: a systematic review and meta-analysis of cost-utility studies. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1027-1040. [PMID: 37604704 DOI: 10.1080/14737167.2023.2249610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/12/2023] [Accepted: 08/14/2023] [Indexed: 08/23/2023]
Abstract
OBJECTIVE To systematically review the cost-utility evidence of TNF-a-i treatment for rheumatoid arthritis (RA) and to estimate the pooled incremental net benefit (INBp). METHODS We selected economic evaluation studies reporting the cost-utility of TNF-a-i compared to other disease-modifying anti-rheumatic drugs (DMARDs) after a systematic search in PubMed, Embase, Scopus, and Tufts Medical Centers' cost-effective analysis registry. The results were reported as pooled INB in purchasing power parity-adjusted US dollars, along with 95% confidence intervals. We used GRADE quality assessment to present summaries of evidence and random-effects meta-analysis to synthesize cost-utility of TNF-a-i. RESULTS We included 86 studies for systematic review, of which 27 for meta-analysis. TNF-a-i is not cost-effective [$ -4,129(-6,789 to -1,469)] compared to other DMARDs but with high heterogeneity. There was no evidence of publication bias (p = 0.447). On separate analysis, TNF-a-i is not cost-effective [$ -4,805(-7,882 to -1,728)] compared to conventional synthetic DMARDs for RA treatment. GRADE assessment indicated very low confidence in pooled cost-utility results and likely presence of risk of bias on the overall ECOBIAS checklist in studies. CONCLUSION Based on the available evidence during the study period, TNF-a-i is not a cost-effective option for treating RA compared to other DMARDs. However, high heterogeneity and low confidence in GRADE quality assessment preclude the results from being generalizable.
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Affiliation(s)
- Sajith Kumar
- Health Technology Assessment Resource Centre, Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
| | - Bhavani Shankara Bagepally
- Health Technology Assessment Resource Centre, Indian Council of Medical Research-National Institute of Epidemiology, Chennai, India
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Sutcliffe M, Nair N, Oliver J, Morgan AW, Isaacs JD, Wilson AG, Verstappen SMM, Viatte S, Hyrich KL, Morris AP, Barton A, Plant D. Pre-defined gene co-expression modules in rheumatoid arthritis transition towards molecular health following anti-TNF therapy. Rheumatology (Oxford) 2022; 61:4935-4944. [PMID: 35377444 PMCID: PMC9707314 DOI: 10.1093/rheumatology/keac204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/31/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND No reliable biomarkers to predict response to TNF inhibitors (TNFi) in RA patients currently exist. The aims of this study were to replicate changes in gene co-expression modules that were previously reported in response to TNFi therapy in RA; to test if changes in module expression are specific to TNFi therapy; and to determine whether module expression transitions towards a disease-free state in responding patients. METHOD Published transcriptomic data from the whole blood of disease-free controls (n = 10) and RA patients, treated with the TNFi adalimumab (n = 70) or methotrexate (n = 85), were studied. Treatment response was assessed using the EULAR response criteria following 3 or 6 months of treatment. Change in transcript expression between pre- and post-treatment was recorded for previously defined modules. Linear mixed models tested whether modular expression after treatment transitioned towards a disease-free state. RESULTS For 25 of the 27 modules, change in expression between pre- and post-treatment in the adalimumab cohort replicated published findings. Of these 25 modules, six transitioned towards a disease-free state by 3 months (P < 0.05), irrespective of clinical response. One module (M3.2), related to inflammation and TNF biology, significantly correlated with response to adalimumab. Similar patterns of modular expression, with reduced magnitude, were observed in the methotrexate cohort. CONCLUSION This study provides independent validation of changes in module expression in response to therapy in RA. However, these effects are not specific to TNFi. Further studies are required to determine whether specific modules could assist molecular classification of therapeutic response.
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Affiliation(s)
- Megan Sutcliffe
- Versus Arthritis Centre for Genetics and Genomics, Division of Musculoskeletal Sciences, The University of Manchester
| | - Nisha Nair
- Versus Arthritis Centre for Genetics and Genomics, Division of Musculoskeletal Sciences, The University of Manchester.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester
| | - James Oliver
- Versus Arthritis Centre for Genetics and Genomics, Division of Musculoskeletal Sciences, The University of Manchester.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester
| | - Ann W Morgan
- School of Medicine, University of Leeds & NIHR Leeds Biomedical Research Centre and NIHR In Vitro Diagnostic Co-operative, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds
| | - John D Isaacs
- Translational & Clinical Research Institution, Newcastle University & Musculoskeletal Unit, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle University, Newcastle upon Tyne, UK
| | - Anthony G Wilson
- School of Medicine & Medical Science, Conway Institute, University College Dublin, Bellfield, Dublin 4, Ireland
| | - Suzanne M M Verstappen
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester.,Versus Arthritis Centre for Epidemiology, Centre for Musculoskeletal Research
| | - Sebastien Viatte
- Versus Arthritis Centre for Genetics and Genomics, Division of Musculoskeletal Sciences, The University of Manchester.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester.,Lydia Becker Institute of Immunology and Inflammation, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Kimme L Hyrich
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester.,Versus Arthritis Centre for Epidemiology, Centre for Musculoskeletal Research
| | - Andrew P Morris
- Versus Arthritis Centre for Genetics and Genomics, Division of Musculoskeletal Sciences, The University of Manchester
| | - Anne Barton
- Versus Arthritis Centre for Genetics and Genomics, Division of Musculoskeletal Sciences, The University of Manchester.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester
| | - Darren Plant
- Versus Arthritis Centre for Genetics and Genomics, Division of Musculoskeletal Sciences, The University of Manchester.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Sciences Centre, Manchester
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Ding Q, Shiltz D, Hossami D, Konieczny AM. The economic burden of biologic disease-modifying antirheumatic drugs in rheumatoid arthritis patients in the United States. Expert Rev Pharmacoecon Outcomes Res 2022; 22:1231-1241. [PMID: 36004551 DOI: 10.1080/14737167.2022.2117690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Previous U.S. economic burden estimates for rheumatoid arthritis (RA) varied from $85.6 to 148.1 billion annually. However, these estimates do not reflect comparative amounts spent on RA treatment options in addition to other medical expenditures. Therefore, this study's goal was to comparatively analyze the overall economic burden of U.S. patients treated for RA using conventional disease-modifying antirheumatic drugs (DMARDs) versus TNF alpha biologic DMARDs. RESEARCH DESIGN AND METHODS This retrospective observational study analyzed Medical Expenditure Panel Survey Household Component data from 2016 to 2018. Healthcare utilization, total medical expenditures, and out-of-pocket expenditures were compared between RA medication groups. RESULTS Three hundred twenty-five adult RA patients experiencing 603 RA-related events, including at least one medical visit, between 2016 and 2018 were identified. Rheumatic arthritis-attributable medical expenditures among patients prescribed DMARDs were $11.4 billion. Average total medical expenditures were significantly higher for the TNF alpha biologic group $26,216.67 (95% CI: $19,502.84-$32,930.5) versus $5,388.52 (95% CI: $2,768.25-$8,008.79) for the conventional DMARD group (p<0.001). CONCLUSIONS RA patients receiving TNF alpha biologics experienced significantly higher total medical and out-of-pocket expenditures; however, they have experienced fewer or no occurrences of high-cost drivers of healthcare utilization compared to patients receiving conventional DMARDs.
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Affiliation(s)
- Qian Ding
- Department of Pharmaceutical Sciences, Ferris State University College of Pharmacy
| | - Dane Shiltz
- Department of Pharmacy Practice, Ferris State University College of Pharmacy
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Fellous S, Rkain H, Ahid S, Abouqal R, Tahiri L, Hmamouchi I, Achemlal L, El Bouchti I, El Maghraoui A, Ghozlani I, Hassikou H, Harzy T, Ichchou L, Mkinsi O, Niamane R, Bahiri R, Allali F. One-year direct costs of biological therapy in rheumatoid arthritis and its predictive factors: data from the Moroccan RBSMR registry. Rheumatol Int 2021; 41:787-793. [PMID: 33386900 DOI: 10.1007/s00296-020-04762-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/24/2020] [Indexed: 11/29/2022]
Abstract
The aim of the study was to estimate the annual direct costs of biological therapies in rheumatoid arthritis (RA), and to establish possible factors associated with those costs. The main data source was the Moroccan registry of biological therapies in rheumatic diseases (RBSMR Registry). We included patients with available 1-year data. Variables related to socio-economic status, disease and biological therapy were collected. Direct costs included prices of biologics, costs of infusions, and subcutaneous injections. Differences in costs across groups were tested by Mann-Whitney and Kruskal-Wallis tests. Correlations analysis was performed in search of factors associated with high costs. We included 197 rheumatoid arthritis patients. The mean age was 52.3 ± 11 years, with female predominance 86.8%. Receiving one of the following therapies: rituximab (n = 132), tocilizumab (n = 37), or TNF-blockers (n = 28). Median one-year direct costs per patient were €1665 [€1472-€9879]. The total annual direct costs were € 978,494. Rituximab, constituted 25.7% of the total annual budget. TNF-blockers and tocilizumab represented 27.3% and 47% of this overall budget, respectively. Although the costs were not significantly different in terms of gender or level of study, the insurance type significantly affected the cost estimation. A positive correlation was found between the annual direct cost and body mass index (r = 0.15, p = 0.04). In Morocco, a developing country, the annual direct costs of biological therapy are high. Our results may contribute to the development of strategies for better governance of these costs.
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Affiliation(s)
- Safaa Fellous
- Department of Rheumatology B, El Ayachi Hospital, Ibn Sina University Hospital, Salé, Morocco.
| | - Hanan Rkain
- Department of Rheumatology B, El Ayachi Hospital, Ibn Sina University Hospital, Salé, Morocco.,Physiology Laboratory, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco
| | - Samir Ahid
- Research Team of Pharmacoeconomics and Pharmacoepidemiology, Mohammed V University, Rabat, Morocco
| | - Redouane Abouqal
- Laboratory of Biostatistical, Clinical and Epidemiological Research, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco
| | - Latifa Tahiri
- Department of Rheumatology B, El Ayachi Hospital, Ibn Sina University Hospital, Salé, Morocco
| | - Ihsane Hmamouchi
- Laboratory of Biostatistical, Clinical and Epidemiological Research, Faculty of Medicine and Pharmacy, Mohammed V University, Rabat, Morocco.,Department of Rheumatology, Provincial Hospital of Temara, Temara, Morocco
| | - Lahsen Achemlal
- Department of Rheumatology, Military Hospital Mohammed V, Ibn Sina University Hospital, Rabat, Morocco
| | - Imane El Bouchti
- Department of Rheumatology, Arrazi University Hospital, Marrakech, Morocco
| | | | - Imad Ghozlani
- Department of Rheumatology, University Hospital of Agadir, Agadir, Morocco
| | - Hasna Hassikou
- Department of Rheumatology, Military Hospital Moulay Ismail, Hassan II University Hospital, Meknès, Morocco
| | - Taoufik Harzy
- Department of Rheumatology, Hassan II University Hospital, Fès, Morocco
| | - Linda Ichchou
- Department of Rheumatology, Mohammed VI University Hospital, Oujda, Morocco
| | - Ouafa Mkinsi
- Department of Rheumatology, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Radouane Niamane
- Department of Rheumatology, Military Hospital Avicenne, Mohammed VI University Hospital, Marrakech, Morocco
| | - Rachid Bahiri
- Department of Rheumatology A, El Ayachi Hospital, Ibn Sina University Hospital, Salé, Morocco
| | - Fadoua Allali
- Department of Rheumatology B, El Ayachi Hospital, Ibn Sina University Hospital, Salé, Morocco
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Drosos AA, Pelechas E, Kaltsonoudis E, Voulgari PV. Therapeutic Options and Cost-Effectiveness for Rheumatoid Arthritis Treatment. Curr Rheumatol Rep 2020; 22:44. [DOI: 10.1007/s11926-020-00921-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Li CKH, Baker K, Jones T, Coulson E, Roberts A, Birrell F. Safety and Tolerability of Subcutaneous Methotrexate in Routine Clinical Practice. Arthritis Care Res (Hoboken) 2020; 73:1306-1311. [PMID: 32475009 DOI: 10.1002/acr.24334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/19/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE To show the safety and efficacy of subcutaneous (SC) methotrexate (MTX) compared to oral MTX, alternative disease-modifying antirheumatic drugs (DMARDs) monotherapy, biologic monotherapy, and combinations (conventional and biologic combination groups) in routine clinical practice. METHODS Clinical and laboratory data were retrospectively analyzed for rheumatology clinic attendances at a large Northeast England hospital trust between January 2014 and January 2018. Rates of adverse events and stop events (transaminitis [serum alanine aminotransferase level of >80 units/liter] or neutropenia [neutrophil count of <2.0 × 109 /liter]) were calculated, with adjustment for duration of DMARD exposure. RESULTS In the present study, 8,394 patients received DMARDs, with 2,093 patients receiving oral MTX and 949 patients receiving SC MTX. The median dose was 15 mg (interquartile range [IQR] 10-20 mg) for oral MTX, and 20 mg (IQR 15-25 mg) for SC MTX (P < 0.0001). Continuation rates were higher for SC MTX therapy when adjusted for follow-up duration, with a rate ratio (RR) of 1.54 (95% confidence interval [95% CI] 1.40-1.70) (P < 0.0001). For the time period assessed, 2,382 patients experienced 4,358 adverse events, with 1,711 incidents of transaminitis and 2,647 incidents of neutropenia recorded. Significantly fewer adverse events were observed in patients who received SC MTX monotherapy versus those who received biologic and combination DMARD therapies (P < 0.01). Compared to oral MTX, SC MTX was associated with a nonsignificant trend toward lower rates of neutropenia, but only a slightly higher rate of transaminitis (RR 1.26 [95% CI 1.07-1.48]) (P = 0.006), despite significantly higher doses of MTX. CONCLUSION Subcutaneous MTX is safe in routine clinical practice. This is the largest study yet reported on SC MTX and provides observational data that SC MTX is continued longer and better tolerated in patients compared to other therapy groups, especially oral MTX.
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Affiliation(s)
- Christien K H Li
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Kenneth Baker
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Tania Jones
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Elizabeth Coulson
- Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Fraser Birrell
- Translational and Clinical Research Institute, Newcastle University and Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
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