title: Abatacept or infliximab for patients with rheumatoid arthritis and inadequate response to methotrexate: an Italian trial-based and real-life cost-consequence analysis.
abstract: OBJECTIVE
  In the 1-year, double-blind, placebo-controlled ATTEST trial, efficacy of abatacept or infliximab versus placebo was reported in patients with rheumatoid arthritis (RA) and an inadequate response to methotrexate (MTX). The current study estimated trial-based and real-life costs of abatacept and infliximab for achieving pre-defined remission or low disease activity state (LDAS).
  
  
  METHODS
  Quantity of drug, serious adverse event (SAE) rates and time (months) in remission or LDAS were taken from ATTEST for the trial-based calculation to derive a cost per remitting/LDAS patient and a cost per patient-month in remission/LDAS. Trial-based and real-life scenarios were performed.
  
  
  RESULTS
  The annual trial-based costs per remitting/LDAS patient were €70.238/€37.208 for abatacept and €85.565/€46.602 for infliximab. In the first 6 months of the ATTEST trial, costs per patient-month in remission/LDAS were higher for abatacept (€11.024 and €6.018, respectively), relative to infliximab (€8.347 and €4.174, respectively). Over the full 12-month trial period cost per month in remission/LDAS estimates were only slightly in favour of infliximab (€6.959/€3.625) relative to abatacept (€7.297/€3.909). Assuming extension of treatment under real life conditions the cost per month in remission/LDAS turned substantially in favour of abatacept (€5.321/€2.819), as compared to infliximab (€7.189/€3.916). The higher initiation cost for abatacept to achieve remission/LDAS would be offset after a total 14.6 and 16.1 months of treatment, respectively, if treatment extended beyond 6 months under real-life conditions. These results proved to be robust when it was assumed that the (i) sharing of vials across patients completely averted infliximab wastage, (ii) AE risks were similar and (iii) onset of response was slower for abatacept.
  
  
  CONCLUSIONS
  Our findings suggest a lower cost-consequence for abatacept during real-life treatment.
authors.affiliation: Department of Internal Medicine, Hospital San Giovanni di Dio, Florence, Italy. maurizio.benucci@asf.toscana.it
authors.forename: Maurizio
authors.initials: M
authors.lastname: Benucci
authors.forename: Wiro B
authors.initials: WB
authors.lastname: Stam
authors.forename: Isabelle
authors.initials: I
authors.lastname: Gilloteau
authors.forename: Karin
authors.initials: K
authors.lastname: Sennfält
authors.forename: Adriana
authors.initials: A
authors.lastname: Leclerc
authors.forename: Andreas
authors.initials: A
authors.lastname: Maetzel
authors.forename: Carlo
authors.initials: C
authors.lastname: Lucioni
mesh_terms: D000069594:Abatacept; D000328:Adult; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000191:economics; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D004311:Double-Blind Method; D016527:Drug Costs; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D017048:Health Care Costs; D006801:Humans; D018796:Immunoconjugates / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D000069285:Infliximab; D007558:Italy; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D008875:Middle Aged; D010919:Placebos; D012074:Remission Induction
chemical_list: D000911:Antibodies, Monoclonal; D018501:Antirheumatic Agents; D018796:Immunoconjugates; D010919:Placebos; D000069594:Abatacept; D000069285:Infliximab; D008727:Methotrexate