title: Rituximab in the treatment of rheumatoid arthritis patients in Italy: a budget impact analysis.
abstract: OBJECTIVE
  The objective of this Budget Impact Analysis is to evaluate the financial implications of a rituximab-based sequencing strategy in the treatment of rheumatoid arthritis in the perspective of the Italian National Health Service.
  
  
  METHODS
  Yearly patients who were eligible for a second-line biological DMARD in Italy were entered into a 5-year model. A Markov chain reproduced the course of this cohort under a number of alternative strategies, including anti-TNF-α cycling and rituximab or abatacept as second and third line agents. The dynamic of the simulation was given by first biological drug failure data, mortality rates, and survival-on-treatment data from published literature. Drug acquisition, administration and monitoring costs were assessed.
  
  
  RESULTS
  Italian patients refractory to a first anti-TNF-α therapy resulted to be about 650 per year, giving a cumulative number of treated patients in five years of 3,240. The anti-TNF-α cycling had a total direct cost which rose from €8.2 million in the first year to €33.8 million in the fifth. The cost per patient of rituximab was lower than the average cost of the anti-TNF-α therapies; the annual difference was around € 4,300. The savings gained from lower individual costs with rituximab were partially offset by the increasing number of patients receiving active medication, resulting in a substantial cost equivalence between third line rituximab and anti-TNF-α cycling scenarios; rituximab, as a second line therapy, produced a savings in total costs of -31.8%. Strategies including abatacept shared the same dynamics, but with higher costs.
  
  
  CONCLUSIONS
  The introduction of rituximab in clinical practice could allow an increase in the number of patients receiving an active rheumatoid arthritis treatment without inflating therapy costs.
authors.affiliation: Rheumatology Unit, Department of Internal Medicine, Nuovo Ospedale di S. Giovanni di Dio, Azienda Sanitaria di Firenze, Florence, Italy. maubenucci@tiscali.it
authors.forename: M
authors.initials: M
authors.lastname: Benucci
authors.forename: S
authors.initials: S
authors.lastname: Iannazzo
authors.forename: O
authors.initials: O
authors.lastname: Zaniolo
authors.forename: L
authors.initials: L
authors.lastname: Sabadini
mesh_terms: D000069594:Abatacept; D058846:Antibodies, Monoclonal, Murine-Derived / Q000191:economics* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000191:economics*; D004359:Drug Therapy, Combination / Q000191:economics; D004363:Drug Utilization / Q000706:statistics & numerical data; D017048:Health Care Costs; D006801:Humans; D018796:Immunoconjugates / Q000191:economics* / Q000627:therapeutic use; D007558:Italy; D005791:Patient Care / Q000191:economics*; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D018796:Immunoconjugates; D000069283:Rituximab; D000069594:Abatacept