Pharmacoeconomic evaluation of treatment effectiveness with selected biologic treatment in rheumatoid arthritis therapy
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Submission date: 2018-04-26
Final revision date: 2018-08-06
Acceptance date: 2018-08-10
Online publication date: 2018-08-31
Publication date: 2018-08-31
Reumatologia 2018;56(4):212–218
Modern treatment of autoimmune diseases is becoming increasingly widely used. We owe it to the continuous and rapid development of biotechnology, molecular biology, immunology, and biochemistry. The proven effectiveness of biological therapy in rheumatoid arthritis (RA) should result in its widespread use. At present, only about 1% of patients with RA have access to biological therapy in Poland.

Material and methods:
The study material was retrospectively collected in the Rheumatology and Systemic Tissue Diseases Clinic and Rheumatology Outpatient Clinic in dr Jan Biziel University Hospital No. 2 in Bydgoszcz 2009–2014. Patients were divided into 3 groups: patient receiving infliximab, etanercept and adalimumab.

The study involved analyses of cost effectiveness. The time horizon of patient documentation analysis ranged from the time a patient was enrolled to infliximab, etanercept or adalimumab therapy until remission of the disease. The majority of patients achieved remission in the case of adalimumab treatment (85.29%), followed by etanercept (74.07%), then infliximab (37.21%). Taking into account the DAS28 parameter, analysis was performed using medical costs of the analyzed treatment regimens. For this purpose, the incremental cost-effectiveness ratio (ICER) was calculated. According to the analysis, obtaining one DAS28 unit, replacing infliximab with etanercept, would cost PLN 40 964 67. Higher costs would be required in the case of replacement of infliximab with adalimumab – PLN 43 076 08. Obtaining one additional DAS28 unit (in this case, a decrease in DAS28 by one unit) by introducing adalimumab instead of etanercept would amount to PLN 45 409 74.

Undoubtedly, the pharmacoeconomic analysis makes it easier to decide on the appropriate treatment. Therefore, its implementation should be a widely used solution not only for RA, but also for other diseases. Health care and other entities’ systems should also be improved in such a way that the data needed for pharmacoeconomic analysis are fully available.

Kobelt G, Kasteng F. Access to innovative treatments in rheumatoid arthritis in Europe. A report prepared for the European Federation of Pharmaceutical Industry Associations (EFPIA) 2009: 1-92.
Orlewska E, Wiland P. Access to biologic treatment for rheumatoid arthritis in Central and Eastern European (CEE) countries. Med Sci Monit 2011; 17: 1-13.
Stajszczyk M. Raport. Biological treatment in rheumatic diseases in Poland in 2013: 11.
Johannesson M, Gerdtham UG. A note on the estimation of the quality – efficiency trade-off for QALYs. J Health Econ 1996; 15: 359-368.
Blumenauer B, Judd M, Cranney A, et al. Etanercept for the treatment of rheumatoid arthritis. Cochrane Database Syst Rev 2003; 4: CD004525.
Navarro-Sarabia F, Ariza-Ariza R, Hernandez-Cruz B, Villanueva I. Adalimumab for treating rheumatoid arthritis. J Rheumatol 2006; 33: 1075-1081.
Chen YF, Jobanputra P, Barton P, et al. A systematic review of the effectiveness of adalimumab, etanercept and infliximab for the treatment of rheumatoid arthritis in adults and an economic evaluation of their cost-effectiveness. Health Technol Assess 2006; 10: 1-229.
Maini R, St Clair EW, Breedveld F, et al. Infliximab (chimeric anti-tumour necrosis factor-monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. Lancet 1999; 354: 1932-1939.
Allaart CF, Lems WF, Huizinga TW. The BeSt way of withdrawing biologic agents. Clin Exp Rheumatol 2013; 31 (Suppl 78): S14-18.
Weinblatt ME, Keystone EC, Furst DE, et al. Adalimumab, a fully human anti–tumor necrosis factor-monoclonal antibody, for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate: the ARMADA trial. Arthritis Rheum 2003; 48: 35-45.
Moreland LW, Schiff MH, Baumgartner SW, et al. Etanercept therapy in rheumatoid arthritis. A randomized, controlled trail. Ann Intern Med 1999; 130: 478-486.
Wiens A, Venson R, Cassyano J, et al. Meta-analysis of the Efficacy and Safety of Adalimumab, Etanercept, and Infliximab for the Treatment of Rheumatoid Arthritis. Pharmacotherapy 2010; 30: 339-353.
Schabert VF, Bruce B, Ferrufino CF, et al. Disability outcomes and dose escalation with etanercept, adalimumab, and infliximab in rheumatoid arthritis patients: a US-based retrospective comparative effectiveness study. Curr Med Res Opin 2012; 28: 569-580.
Nagasawa H, Kameda H, Sekiguchi N, et al. Improvement of the HAQ score by infliximab treatment in patients with RA: its association with disease activity and joint destruction. Mod Rheumatol 2009; 19: 166-172.
Malottki K, Barton P, Tsourapas A, et. al. Adalimumab, etanercept, infliximab, rituximab and abatacept for the treatment of rheumatoid arthritis after the failure of a TNF inhibitor: a systematic review and economic evaluation. Health Technol Assess 2011; 15: 1-278.
Kaczor MP, Wójcik R. An economic analysis of TNF- antagonists for rheumatoid arthritis in Polish settings. Reumatologia 2007; 45: 268-275.
Wailoo AJ, Bansback N, Brennan A, et al. Biologic Drugs for Rheumatoid Arthritis in the Medicare Program. Arthritis Rheum 2008, 58: 939-946.
Hidalgo-Vega A, Villoro R, Blasco JA, et al. Cost-utility analysis of certolizumab pegol versus alternative tumour necrosis factor inhibitors available for the treatment of moderate-to-severe active rheumatoid arthritis in Spain. Cost Eff Resour Alloc 2015; 13: 11.
Savova A, Marinov L, Georgieva S, et. al. Pharmacoeconomic assessment of biosimilar infliximab for the therapy of rheumatoid diseases in the Bulgarian health care setting – a Markov model. World J Pharm Pharm Sci 2014; 3: 147-153.
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