Korean Journal of Clinical Pharmacy (한국임상약학회지)

Korean College Of Clinical Pharmacy (한국임상약학회)
권호 표지

Cost-Minimization Analysis of Biologic Disease-Modifying Antirheumatic Drugs Administered by Subcutaneous Injections in Patients with Rheumatoid Arthritis

피하주사로 투여하는 생물학적 항류마티스 제제의 비용 최소화 연구

  • Received : 2016.02.23
  • Accepted : 2016.03.12
  • Published : 2016.03.31
Download PDF
⟨ Previous Next ⟩

Abstract

Background: The subcutaneous formulation of biologic disease-modifying antirheumatic drugs (DMARDs) was preferred due to favored self-administration and would be an economical treatment option for patients with rheumatoid arthritis. This study was to compare the economic impact of biologic DMARDs administered by subcutaneous injection in patients with rheumatoid arthritis who had inadequate response to conventional DMARDs. Methods: The cost-minimization analysis was conducted to estimate the lifetime health care costs of treatment sequences with subcutaneous biologic DMARDs as first-line therapy from a health care system perspective. The Markov model was developed to represent the transitions through treatment sequences based on American College of Rheumatology response rate and discontinuation rate. The health care costs comprised the cost of medications, administration, dispensing, outpatient visits, test/diagnostic examination, palliative therapy and treatment of serious infection. All costs were expressed in 2016 Korean Won (KRW) and discounted at 5%. Results: The mean lifetime health care cost per patient was lowest in the etanercept sequence, which was estimated at KRW 63,441,679. The incremental costs of the treatment sequence started with adalimumab, golimumab, abatacept, and tocilizumab were KRW 7,985,730, KRW 4,064,669, KRW 2,869,947, and KRW 4,282,833, respectively, relative to etanercept sequence. These differences in costs mainly were attributable to medication costs. One-way and probabilistic sensitivity analyses confirmed that etanercept represented the option with the lowest cost compared with comparators. Conclusion: This study found that etanercept is likely a cost-saving treatment option among subcutaneous biologic DMARDs in patients with rheumatoid arthritis.

Keywords

References

  1. National Institute of Arthritis and Musculoskeletal and Skin Diseases. Handout on Health: Rheumatoid Arthritis, August 2014. Retrieved July 2, 2015. Available from: http://www.niams.nih.gov/health_info/Rheumatic_Disease/default.asp. Accessed on Feb 2, 2016.
  2. Park NG, Kim WK, Shin DH, et al. Prevalence of osteoarthritis and rheumatoid arthritis in two communities in Korea. J Korean Rheum Assoc 2003;10:151-157.
  3. Hur NW, Choi CB, Uhm WS, et al. The Prevalence and trend of arthritis in Korea: results from Korea National Health and Nutrition Examination Surveys. J Korean Rheum Assoc 2008;15:11-26. https://doi.org/10.4078/jkra.2008.15.1.11
  4. Choi HJ, Han WJ, Im JS, et al. The Prevalence and clinical features of musculoskeletal diseases in Incheon: results from chronic disease management surveys. J Korean Rheum Assoc 2009;16:281-290. https://doi.org/10.4078/jkra.2009.16.4.281
  5. Health Insurance Review and Assessment Service. Disease/Service medical statistics M05, M06. Available from: http://opendata.hira.or.kr. Accessed on Feb 16, 2016.
  6. Singh JA, Saag KG, Bridges SL Jr, et al. 2015 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. Arthritis Rheumatol 2016;68(1):1-26. https://doi.org/10.1002/art.39480
  7. Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Ann Rheum Dis 2014;73(3):492-509. https://doi.org/10.1136/annrheumdis-2013-204573
  8. Weinblatt ME, Keystone EC, Furst DE, et al. Adalimumab, a fully human anti-tumor necrosis factor alpha monoclonal antibody, for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate: the ARMADA trial. Arthritis Rheum 2003;48(1):35-45. https://doi.org/10.1002/art.10697
  9. Moreland LW, Baumgartner SW, Schiff MH, et al. Treatment of rheumatoid arthritis with a recombinant human tumor necrosis factor receptor (p75)-Fc fusion protein. N Engl J Med 1997;337(3):141-7. https://doi.org/10.1056/NEJM199707173370301
  10. Kremer J, Ritchlin C, Mendelsohn A, et al. Golimumab, a new human anti-tumor necrosis factor alpha antibody, administered intravenously in patients with active rheumatoid arthritis: Forty-eight-week efficacy and safety results of a phase III randomized, double-blind, placebocontrolled study. Arthritis Rheum 2010;62(4):917-28. https://doi.org/10.1002/art.27348
  11. Maini R, St Clair EW, Breedveld F, et al. Infliximab (chimeric antitumour necrosis factor alpha monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. ATTRACT Study Group. Lancet 1999; 354(9194):1932-9. https://doi.org/10.1016/S0140-6736(99)05246-0
  12. Kremer JM, Westhovens R, Leon M, et al. Treatment of rheumatoid arthritis by selective inhibition of T-cell activation with fusion protein CTLA4Ig. N Engl J Med 2003;349(20):1907-15. https://doi.org/10.1056/NEJMoa035075
  13. Smolen JS, Beaulieu A, Rubbert-Roth A, et al. Effect of interleukin-6 receptor inhibition with tocilizumab in patients with rheumatoid arthritis (OPTION study): a double-blind, placebo-controlled, randomised trial. Lancet 2008;371(9617):987-97. https://doi.org/10.1016/S0140-6736(08)60453-5
  14. Burmester GR, Rubbert-Roth A, Cantagrel A, et al. A randomised, double-blind, parallel-group study of the safety and efficacy of subcutaneous tocilizumab versus intravenous tocilizumab in combination with traditional disease-modifying antirheumatic drugs in patients with moderate to severe rheumatoid arthritis (SUMMACTA study). Ann Rheum Dis 2014;73(1):69-74. https://doi.org/10.1136/annrheumdis-2013-203523
  15. Iwahashi M, Inoue H, Matsubara T, et al. Efficacy, safety, pharmacokinetics and immunogenicity of abatacept administered subcutaneously or intravenously in Japanese patients with rheumatoid arthritis and inadequate response to methotrexate: a Phase II/III, randomized study. Mod Rheumatol 2014;24(6):885-91. https://doi.org/10.3109/14397595.2014.881954
  16. Huynh TK, Ostergaard A, Egsmose C, et al. Preferences of patients and health professionals for route and frequency of administration of biologic agents in the treatment of rheumatoid arthritis. Patient Prefer Adherence 2014;8:93-9.
  17. Sylwestrzak G, Liu J, Stephenson JJ, et al. Considering patient preferences when selecting anti-tumor necrosis factor therapeutic options. Am Health Drug Benefits 2014;7(2):71-81.
  18. Keystone E, Alkhalaf A, Makkawy M. Subcutaneous abatacept in rheumatoid arthritis: current update. Expert Opin Biol Ther 2015; 15(8):1221-30. https://doi.org/10.1517/14712598.2015.1065248
  19. Chilton F, Collett RA. Treatment choices, preferences and decisionmaking by patients with rheumatoid arthritis. Musculoskeletal Care 2008;6(1):1-14. https://doi.org/10.1002/msc.110
  20. McLaughlin M, Ostor A. Safety of subcutaneous versus intravenous tocilizumab in combination with traditional disease-modifying antirheumatic drugs in patients with rheumatoid arthritis. Expert Opin Drug Saf 2015;14(3):429-37. https://doi.org/10.1517/14740338.2015.998198
  21. Roman Ivorra JA, Ivorra J, Monte-Boquet E, et al. Cost analysis of biologic drugs in rheumatoid arthritis first line treatment after methotrexate failure according to patients' body weight. Reumatol Clin 2015.
  22. Jin JF, Zhu LL, Chen M, et al. The optimal choice of medication administration route regarding intravenous, intramuscular, and subcutaneous injection. Patient Prefer Adherence 2015;9:923-42.
  23. Buckley F, Finckh A, Huizinga TW, et al. Comparative Efficacy of Novel DMARDs as Monotherapy and in Combination with Methotrexate in Rheumatoid Arthritis Patients with Inadequate Response to Conventional DMARDs: A Network Meta-Analysis. J Manag Care Spec Pharm 2015;21(5):409-23. https://doi.org/10.18553/jmcp.2015.21.5.409
  24. Aaltonen KJ, Virkki LM, Malmivaara A, et al. Systematic review and meta-analysis of the efficacy and safety of existing TNF blocking agents in treatment of rheumatoid arthritis. PLoS One 2012;7(1): e30275. https://doi.org/10.1371/journal.pone.0030275
  25. Gallego-Galisteo M, Villa-Rubio A, Alegre-del Rey E, et al. Indirect comparison of biological treatments in refractory rheumatoid arthritis. J Clin Pharm Ther 2012;37(3):301-7. https://doi.org/10.1111/j.1365-2710.2011.01292.x
  26. Park SJ. Medical cost analysis of TNF antagonist in patients with rheumatoid arthritis using national health insurance claim data. M.S. Graduate School of Clinical pharmacy, Sookmyung Women's University. 2011.
  27. Korean Statistical Information Service. National Physical Fitness Survey: Weight of adult in 2013. Available from http://kosis.kr. Accessed on Feb 11, 2016.
  28. Du Pan SM, Dehler S, Ciurea A, et al. Comparison of drug retention rates and causes of drug discontinuation between anti-tumor necrosis factor agents in rheumatoid arthritis. Arthritis Rheum 2009;61(5):560-8. https://doi.org/10.1002/art.24463
  29. Sokka T, Abelson B, Pincus T. Mortality in rheumatoid arthritis: 2008 update. Clin Exp Rheumatol 2008;26(5 Suppl 51):S35-61.
  30. Korean Statistical Information Service. Complete Life Table 2014. Available from: http://kosis.kr/. Accessed on Feb 18, 2016.
  31. Health Insurance Review and Assessment. Drug weighted average price in 2014. Available from: http://www.hira.or.kr. Accessed on Feb 11, 2016.
  32. Health Insurance Review and Assessment. Drug reimbursement list and listed drug price. Available from: http://www.hira.or.kr. Accessed on Feb 18, 2016.
  33. Ministry of Food and Drug Safety. Drug Information. Available from: http://drug.mfds.go.kr. Accessed on Feb 18, 2016.
  34. Health Insurance Review and Assessment. Korean Medical Service Fee. Available from: http://www.hira.or.kr. Accessed on Feb 18, 2016.
  35. Gomez-Reino, A. Hazra, C. Fosser, et al. Post-Hoc Analysis Of Serious Infection Events and Selected Clinical Factors In Rheumatoid Arthritis Patients Treated With Tofacitinib. In: Poster presented at the ACR/ARHP Annual Scientific Meeting. San Diego, CA, USA, October 25-30, 2013
  36. Health Insurance Review and Assessment. National Health Insurance Statistical Yearbook 2013. Available from: http://www.hira.or.kr. Accessed on Feb 18, 2016.
  37. Korean Statistical Information Service in Statistics Korea. Consumer Price Index in Health Care. Available from: http://kosis.kr. Accessed on Feb 18, 2016.
  38. Health Insurance Policy Institute in National Health Insurance Service. Survey on National Health Insurance in 2013. Available from: http://kosis.kr. Accessed on Feb 18, 2016.
  39. Wolfe F, Zwillich SH. The long-term outcomes of rheumatoid arthritis: a 23-year prospective, longitudinal study of total joint replacement and its predictors in 1,600 patients with rheumatoid arthritis. Arthritis Rheum 1998;41(6):1072-82. https://doi.org/10.1002/1529-0131(199806)41:6<1072::AID-ART14>3.0.CO;2-G
  40. Lee TJ, Park BH, Son HK, et al. Cost of illness and quality of life of patients with rheumatoid arthritis in South Korea. Value Health 2012; 15(1 Suppl):S43-9. https://doi.org/10.1016/j.jval.2011.11.020
  41. Briggs A, Claxton K, Sculpher M, et al. Decision Modelling for Health Economic Evaluation, 1st ed. London: Oxford University Press, 2006; 108.
  42. Fragoulakis V, Vitsou E, Hernandez AC, et al. Economic evaluation of anti-TNF agents for patients with rheumatoid arthritis in Greece. Clinicoecon Outcomes Res 2015;7:85-93.
  43. Bonafede MM, Gandra SR, Watson C, et al. Cost per treated patient for etanercept, adalimumab, and infliximab across adult indications: a claims analysis. Adv Ther 2012;29(3):234-48. https://doi.org/10.1007/s12325-012-0007-y
  44. Schabert VF, Watson C, Joseph GJ, et al. Costs of tumor necrosis factor blockers per treated patient using real-world drug data in a managed care population. J Manag Care Pharm 2013;19(8):621-30.
  45. Ariza R, Van Walsem A, Canal C, et al. Cost-minimization analysis of subcutaneous abatacept in the treatment of rheumatoid arthritis in Spain. Farm Hosp 2014;38(4):257-65.