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Triple Therapy Seen as More Cost-effective Than Etanercept Therapies
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Compared with etanercept plus methotrexate, triple therapy with methotrexate, sulfasalazine and hydroxychloroquine was more cost-effective in patients with early aggressive rheumatoid arthritis, according to an analysis.
Hawre Jalal, MD, PhD, in the Department of Health Policy and Management at the University of Pittsburgh, and colleagues built a 5-year Markov cohort model utilizing individual-level data from the TEAR trial, as well as published literature and supplemental clinical data. They determined costs in U.S. dollars and effectiveness in quality-adjusted life-years (QALYs) for immediate and step-up triple therapy, as well as immediate and step-up etanercept plus methotrexate.
Jalal and colleagues found the immediate therapies were more effective than the step-up treatments. In addition, the etanercept plus methotrexate therapy was more costly than triple therapy, mostly due to treatment cost. When the time horizon was 1 year and 2 years, immediate triple therapy was the most effective and least expensive strategy. When the horizon was 5 years, etanercept plus methotrexate became slightly more effective (3.483 vs. 3.476 QALYs), but was still more expensive ($148,800 vs. $52,600), creating an incremental cost-effectiveness ratio of $12.5 million per QALY. These results remained robust for both one-way deterministic and joint probabilistic sensitivity analyses.
The researchers wrote a significant reduction in biologic prices is required for immediate etanercept to become cost-effective in early aggressive rheumatoid arthritis (RA).
“With substantial reduction in biologic agent cost or low pricing of the soon-to-be-available biosimilars, [immediate etanercept] IE could be cost-effective if biosimilars are priced around 5% of the current innovator price in early aggressive RA,” Jalal and colleagues wrote. – by Will Offit
Disclosure: Jalal reports no relevant financial disclosures. Please see the full study for a list of all other relevant disclosures.
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