Cost-effectiveness treatment with Rituximab in patients with rheumatoid arthritis in real life.
The cost-effectiveness of treatments that have the potential to change the "natural history" of a chronic progressive disease has to be evaluated over the long term. Cost-effectiveness estimates have been based on the concept that, with treatment, patients will not progress to the next level(s) of disease severity or will take a longer time to progress, thus avoiding or delaying the high costs and low utility associated with more severe disease. This analysis focused on the use of Rituximab in treating patients with moderate to severe RA for whom at least one anti-TNFα blocking agent had failed. The aim of our study was to evaluate the cost-effectiveness in 32 patients with rheumatoid arthritis in therapy with a single infusion of Rituximab 1,000 mg given on days 1 and 15 of each month for 1 year. After 6 months of treatment, we observed for all 32 patients a total quality-adjusted life year (QALY) gained of 11,840 with an average of 0.37 QALY for a single patient, a treatment cost of euro 5,610 and a QALY/cost ICER (incremental cost-effectiveness ratio) of euro 15,114. After 1 year of treatment, we observed data for 28 patients with a total QALY gained of 11,480 with an average of 0.41 QALY for a single patient, a treatment cost of euro 9,690 and a QALY/cost ICER (incremental cost-effectiveness ratio) of euro 23,696. The benefit of using Rituximab is cost-effectiveness with a QALY/gained under the acceptable threshold of euro 50,000 in our observational study. These are important data for discussion from the economic point of view when we choose a biologic therapy for rheumatoid arthritis in clinical practice.
Benucci
Maurizio
M
Rheumatology Unit, Department of Internal Medicine, Ospedale di S. Giovanni di Dio, Azienda Sanitaria di Firenze, Via Torregalli 3, 50143 Florence, Italy. maubenucci@tiscali.it
Saviola
Gianantonio
G
Baiardi
Paola
P
Manfredi
Mariangela
M
D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000191:economics / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000473:pathology / Q000503:physiopathology; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D005260:Female; D006304:Health Status; D006801:Humans; D007596:Joints / Q000473:pathology / Q000503:physiopathology; D008297:Male; D017063:Outcome Assessment, Health Care; D019057:Quality-Adjusted Life Years; D020127:Recovery of Function; D000069283:Rituximab
D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D000069283:Rituximab
Rheumatology (Oxford). 2008 Apr;47(4):507-13
18304941
Ann Rheum Dis. 2004 Jan;63(1):4-10
14672883
J Health Econ. 1986 Mar;5(1):1-30
10311607
Rheumatology (Oxford). 2000 Oct;39(10):1159-61
11035144
Clin Exp Rheumatol. 2010 Sep-Oct;28(5):722-7
20883636
Arthritis Rheum. 2002 Sep;46(9):2310-9
12355478
Clin Exp Rheumatol. 2002 Jul-Aug;20(4):505-15
12175106
Joint Bone Spine. 2008 Dec;75(6):688-95
18951825
Arthritis Rheum. 2007 May;56(5):1417-23
17469098
Arthritis Rheum. 1980 Feb;23(2):137-45
7362664
Scand J Rheumatol. 2007 May-Jun;36(3):179-83
17657670
Int J Technol Assess Health Care. 2009 Apr;25(2):181-9
19331709
Curr Med Res Opin. 2008 Sep;24(9):2639-50
18687164
Rheumatology (Oxford). 2010 Apr;49(4):767-77
20100793
Ann Rheum Dis. 2005 Jul;64(7):995-1002
15550533
Clin Exp Rheumatol. 2005 Nov-Dec;23(6):819-28
16396700
Int J Immunopathol Pharmacol. 2009 Oct-Dec;22(4):1147-52
20074482
Arthritis Rheum. 2006 Sep;54(9):2793-806
16947627
Ann Rheum Dis. 2003 Dec;62(12):1195-8
14644858