title: [Cost-minimization analysis of subcutaneous abatacept in the treatment of rheumatoid arthritis in Spain].
abstract: OBJECTIVE
  To compare the cost of treating rheumatoid arthritis patients that have failed an initial treatment with methotrexate, with subcutaneous abatacept versus other first-line biologic disease-modifying antirheumatic drugs.
  
  
  METHODS
  Subcutaneous abatacept was considered comparable to intravenous abatacept, adalimumab, certolizumab pegol, etanercept, golimumab, infliximab and tocilizumab, based on indirect comparison using mixed treatment analysis. A cost-minimization analysis was therefore considered appropriate. The Spanish Health System perspective and a 3 year time horizon were selected. Pharmaceutical and administration costs (Euros 2013) of all available first-line biological disease-modifying antirheumatic drugs were considered. Administration costs were obtained from a local costs database. Patients were considered to have a weight of 70 kg. A 3% annual discount rate was applied. Deterministic and probabilistic sensitivity analyses were performed.
  
  
  RESULTS
  Subcutaneous abatacept proved in the base case to be less costly than all other biologic antirrheumatic drugs (ranging from Euros -831.42 to Euros -9,741.69 versus infliximab and tocilizumab, respectively). Subcutaneous abatacept was associated with a cost of Euros 10,760.41 per patient during the first year of treatment and Euros 10,261.29 in subsequent years. The total 3-year cost of subcutaneous abatacept was Euros 29,953.89 per patient. Sensitivity analyses proved the model to be robust. Subcutaneous abatacept remained cost-saving in 100% of probabilistic sensitivity analysis simulations versus adalimumab, certolizumab, etanercept and golimumab, in more than 99.6% versus intravenous abatacept and tocilizumab and in 62.3% versus infliximab.
  
  
  CONCLUSIONS
  Treatment with subcutaneous abatacept is cost-saving versus intravenous abatacept, adalimumab, certolizumab, etanercept, golimumab, infliximab and tocilizumab in the management of rheumatoid arthritis patients initiating treatment with biological antirheumatic drugs.
authors.affiliation: Reumatologia. Hospital Universitario Virgen Macarena. Sevilla.. ioyaguez@porib.com.
authors.forename: R
authors.initials: R
authors.lastname: Ariza
authors.affiliation: MAPI Consultancy. The Netherlands.. ioyaguez@porib.com.
authors.forename: A
authors.initials: A
authors.lastname: Van Walsem
authors.affiliation: Pharmaeconomics Department. Bristol-Myers Squibb. Iberia. Madrid.. ioyaguez@porib.com.
authors.forename: C
authors.initials: C
authors.lastname: Canal
authors.affiliation: Pharmaeconomics & Outcomes Research Iberia. Spain.. ioyaguez@porib.com.
authors.forename: C
authors.initials: C
authors.lastname: Roldán
authors.affiliation: Pharmaeconomics Department. Bristol-Myers Squibb. Iberia. Madrid.. ioyaguez@porib.com.
authors.forename: L
authors.initials: L
authors.lastname: Betegón
authors.affiliation: Pharmaeconomics & Outcomes Research Iberia. Spain.. ioyaguez@porib.com.
authors.forename: I
authors.initials: I
authors.lastname: Oyagüez
authors.affiliation: MAPI Consultancy. The Netherlands.. ioyaguez@porib.com.
authors.forename: K
authors.initials: K
authors.lastname: Janssen
mesh_terms: D000069594:Abatacept / Q000008:administration & dosage* / Q000191:economics*; D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000191:economics*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics*; D017046:Cost Savings; D003365:Costs and Cost Analysis; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D007279:Injections, Subcutaneous; D013030:Spain
chemical_list: D018501:Antirheumatic Agents; D000069594:Abatacept