Biosimilars cost effective vs. leflunomide in rheumatoid arthritis
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Key takeaways:
- In patients with RA not responding to methotrexate, beginning with a biosimilar DMARD was cost-effective vs. a conventional synthetic DMARD.
- Findings “suggest the need to update clinical treatment guidelines.”
In patients with rheumatoid arthritis who have an inadequate response to methotrexate, a treatment sequence beginning with a biosimilar appeared cost-effective compared with leflunomide, according to data published in JAMA Network Open.
“A major barrier preventing the use of [biologic disease-modifying antirheumatic drugs (bDMARDs)] is the substantial drug cost associated with them,” Kuan Peng, MHS, of the University of Hong Kong, and colleagues wrote. “The cost-effectiveness of bDMARDs, indicating the trade-off between increased medication expenditure and the additional health benefit, is vital for public formulary enlisting and reimbursement decisions.
“CT-P13 (biosimilar infliximab) and ABP-501 (biosimilar adalimumab) are two biosimilars approved in Hong Kong since 2020, with a price reduction range from 54% to 87% compared with their reference products,” they added. “The substantial price reduction is expected to reshape the landscape of biosimilar use and indicate an opportunity to access bDMARDs directly after methotrexate failure.”
To determine the cost-effectiveness of a treatment sequence beginning with a biosimilar vs. one beginning with a conventional synthetic DMARD, Peng and colleagues created a multistate Markov transition model that simulated lifetime disease progression for 10,000 hypothetical patients with RA and inadequate methotrexate response.
Model inputs were derived from Hong Kong electronic medical records for 25,099 patients diagnosed with RA (mean age, 56 years) from 2000 to 2021. In the model, patients were treated initially with either leflunomide (Arava, Sanofi), biosimilar infliximab or biosimilar adalimumab and, depending on their response, received TNF inhibitors, non-TNF inhibitor DMARDs, Janus kinase inhibitors and supportive care — all in combination with background methotrexate.
According to the researchers, both the biosimilar sequences resulted in lower lifetime health care costs and greater quality-adjusted life-years. Treatment initiated with leflunomide presented $154,632 in lifetime health care costs and a gain of 14.82 quality-adjusted life-years. Meanwhile, starting treatment with biosimilar infliximab resulted in $152,326 in lifetime health care costs and 15.35 quality-adjusted life-years, with biosimilar adalimumab demonstrating $145,419 in costs and 15.55 quality-adjusted life-years.
In addition, the researchers referenced the 2022 gross domestic product of Hong Kong to set a pre-defined willingness-to-pay threshold of $48,555 per quality-adjusted life-year gain. A probabilistic sensitivity analysis showed the biosimilar adalimumab treatment sequence had a 91% chance of being a cost-effective strategy, while biosimilar infliximab had 9% chance and leflunomide had a 0% chance, according to the researchers.
“Our findings suggest that under the premise of an acceptable budget and well-evaluated opportunity costs, Hong Kong’s local health care agencies should actively promote the inclusion of biosimilar DMARDs in the medical insurance catalog,” Peng and colleagues wrote.
“From the Hong Kong Public institution perspective, treatment sequences initiated with biosimilar DMARDs were cost-effective compared with treatment sequence initiated with leflunomide among patients with RA and an inadequate methotrexate response,” they added. “This study can serve to inform health care stakeholders, rheumatologists, and patients with the unmet needs of bDMARDs about the benefits and financial feasibility of biosimilar DMARDs.”
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