Performance Improvement 2008. What Are the Costs and Benefits of Biologic Therapies for Treating Rheumatoid Arthritis?


Under this study, the costs and health benefits to Medicare beneficiaries of four biologics used to treat rheumatoid arthritis were analyzed. The Medicare Replacement Drug Demonstration expanded coverage of selected biologic drugs, including those used for rheumatoid arthritis patients. The study included a cost-utility analysis of a decision model. Data sources included meta-analysis of randomized controlled trials and data from the National Data Bank for Rheumatic Diseases, a large longitudinal outcomes data source. The target population was Medicare beneficiaries with rheumatoid arthritis for whom a previous biologic drug had not failed. The Medicare interventions tested were: etanercept , adalimumab , anakinra and infliximab. Outcomes measured included costs, quality adjusted life years, and incremental cost effectiveness ratios.

Anakinra was the least effective and least costly strategy. Etanercept, adalimumab and infliximab were similar in terms of effectiveness but infliximab was more costly. At a threshold cost effectiveness ratio of $50,000 per quality-adjusted life year, the probability that infliximab would be cost effective relative to the other biologics is less than 1 percent. The findings were robust to a range of sensitivity analyses. Only if the dose of infliximab remained constant over time would this likely be a cost effective strategy. The analysis also considered whether it was cost effective to move to another biologic after failed response with one biologic (sequential use). Etanercept or adalimumab were cost effective compared to infliximab whereas anakinra was a less effective alternative.

Report Title: The Cost Effectiveness of Etanercept, Adalimumab, and Anakinra in Comparison to Infliximab in the Treatment of Patients with Rheumatoid Arthritis in the Medicare Program, Sponsor: CMS-ORDI, Office of Research, Development, and Information
Federal Contact: Penny Mohr, 410-786-6502
Sheffield University School of Health and Related Research

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