■在对甲氨蝶呤反应不足的类风湿性关节炎(RA)患者中,与目前治疗指南推荐的常规合成DMARDs相比,使用生物类似药控抗风湿药(DMARDs)启动的治疗序列提供了更好的临床疗效;但其成本效益证据尚不清楚.
■在甲氨蝶呤与来氟米特失败后,评估使用生物仿制药DMARD开始的治疗顺序的成本效益,并告知处方清单决定。
■这项经济评估的成本效益分析是在香港一家公共机构使用马尔可夫疾病转移模型来模拟RA患者的终生疾病进展和费用,2022年使用货币价值。进行了情景和敏感性分析,以检验建模结论的内部有效性。参与者包括2000年至2021年诊断为RA的患者,他们从当地电子病历中回顾性检索以生成模型输入参数。从2023年1月至2024年3月进行统计分析。
■该模型评估了使用生物仿制药英夫利昔单抗(CT-P13)启动的3种竞争性治疗序列,生物仿制药阿达木单抗(ABP-501),和来氟米特;全部与甲氨蝶呤联合使用。
■模拟队列的终身医疗保健成本和质量调整寿命年(QALY)。
■总共,确定了25099例RA患者(平均[SD]年龄,56[17]岁;19469[72.7%]女性)。在基本情况分析中,来氟米特开始的治疗顺序的终生医疗保健费用和QALYs分别为154632美元和14.82美元QALYs,分别用于生物仿制药英夫利昔单抗,它们是152-326美元和15.35美元的QALY,分别;对于生物仿制药阿达木单抗,它们是145419美元和15.55美元的QALY,分别。与来氟米特序列相比,两种生物相似序列均具有更低的成本和更高的QALY。在确定性敏感性分析中,比较英夫利昔单抗序列与来氟米特序列和阿达木单抗序列与来氟米特序列的增量成本-效果比(US$/QALY)分别为-15797至-8615和-9088至10238,均低于预定义的支付意愿阈值(48555美元/QALY收益)。在概率敏感性分析中,来氟米特开始治疗序列的概率,生物仿制药英夫利昔单抗,Biosmilaradalimumab在10000次迭代中的成本效益为0%,9%,91%,分别。
■在这项经济评估研究中,在治疗初始甲氨蝶呤治疗失败的RA患者方面,与使用来氟米特开始的治疗顺序相比,使用生物仿制药DMARDs开始的治疗顺序具有成本效益.这些结果表明,需要在甲氨蝶呤治疗RA患者失败后立即更新临床治疗指南,以启动生物仿制药。
UNASSIGNED: Among patients with rheumatoid arthritis (RA) who had an inadequate response to methotrexate, a treatment sequence initiated with biosimilar disease-modifying antirheumatic drugs (DMARDs) provides better clinical efficacy compared with conventional synthetic DMARDs recommended by current treatment guidelines; but its cost-effectiveness evidence remains unclear.
UNASSIGNED: To evaluate the cost-effectiveness of the treatment sequence initiated with biosimilar DMARDs after failure with methotrexate vs leflunomide and inform formulary listing decisions.
UNASSIGNED: This economic evaluation\'s cost-effectiveness analysis was performed at a Hong Kong public institution using the Markov disease transition model to simulate the lifetime disease progression and cost for patients with RA, using monetary value in 2022. Scenario and sensitivity analyses were performed to test the internal validity of the modeling conclusion. Participants included patients diagnosed with RA from 2000 to 2021 who were retrieved retrospectively from local electronic medical records to generate model input parameters. Statistical analysis was performed from January 2023 to March 2024.
UNASSIGNED: The model assesses 3 competing treatment sequences initiated with biosimilar
infliximab (CT-P13), biosimilar adalimumab (ABP-501), and leflunomide; all used in combination with methotrexate.
UNASSIGNED: Lifetime health care cost and quality-adjusted life-years (QALYs) of the simulated cohort.
UNASSIGNED: In total, 25 099 patients with RA were identified (mean [SD] age, 56 [17] years; 19 469 [72.7%] women). In the base-case analysis, the lifetime health care cost and QALYs for the treatment sequence initiated with leflunomide were US $154 632 and 14.82 QALYs, respectively; for biosimilar
infliximab, they were US $152 326 and 15.35 QALYs, respectively; and for biosimilar adalimumab, they were US $145 419 and 15.55 QALYs, respectively. Both biosimilar sequences presented lower costs and greater QALYs than the leflunomide sequence. In the deterministic sensitivity analysis, the incremental cost-effectiveness ratio (US$/QALY) comparing biosimilar
infliximab sequence vs leflunomide sequence and biosimilar adalimumab sequence vs leflunomide sequence ranged from -15 797 to -8615 and -9088 to 10 238, respectively, all below the predefined willingness-to-pay threshold (US $48 555/QALY gain). In the probabilistic sensitivity analysis, the probability of treatment sequence initiated with leflunomide, biosimilar
infliximab, and biosmilar adalimumab being cost-effective out of 10 000 iterations was 0%, 9%, and 91%, respectively.
UNASSIGNED: In this economic evaluation study, the treatment sequences initiated with biosimilar DMARDs were cost-effective compared with the treatment sequence initiated with leflunomide in managing patients with RA who experienced failure with the initial methotrexate treatment. These results suggest the need to update clinical treatment guidelines for initiating biosimilars immediately after the failure of methotrexate for patients with RA.