title: Treatment of moderate rheumatoid arthritis with different strategies in a health resource-limited setting: a cost-effectiveness analysis in the era of biosimilars.
abstract: OBJECTIVE
  This paper aims to explore the cost-effectiveness of reduced doses or discontinuation of etanercept biosimilar (Yisaipu) in patients with moderately active rheumatoid arthritis (RA).
  
  
  METHODS
  A discrete event simulation model was developed to project lifetime medical costs and quality-adjusted life-years (QALYs) in moderately active RA. Strategies starting with Yisaipu 50 mg/week for nine months following Yisaipu 50 mg/week, 25 mg/week or MTX maintenance were compared. Resource consumptions related to RA were estimated from the perspective of the Chinese health care system. An endpoint of the American College of Rheumatology (ACR) response was used to estimate the utility scores. Uncertainty in model parameters was analysed by sensitivity analyses.
  
  
  RESULTS
  When using ACR as an endpoint for determining successful treatment, strategies starting with Yisaipu 50 mg/week for nine months following Yisaipu 50 mg/week or 25 mg/week maintenance showed the greatest number of QALYs gained (nearly 11.9 and 11.3 with or without rituximab after the failure of Yisaipu, respectively). If decision makers use a threshold of 3×the per capita GDP of China or Shanghai City in 2012, then the strategies most likely to be cost-effective are initial treatment with Yisaipu 50 mg/week for nine months following MTX maintenance and Yisaipu 25 mg/week maintenance, respectively. Results were sensitive to the cost of Yisaipu.
  
  
  CONCLUSIONS
  The analysis indicates that, in China, replacing branded etanercept with Yisaipu is likely to be a cost-effective strategy in patients with moderately active RA.
authors.affiliation: Clinical Outcomes and Economics Group, Department of Pharmacy, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Wu
authors.affiliation: Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Song
authors.affiliation: Department of Medicine, Section of Rheumatology, Yale University School of Medicine, New Haven, USA.
authors.forename: Lin
authors.initials: L
authors.lastname: Leng
authors.affiliation: Department of Medicine, Section of Rheumatology, Yale University School of Medicine, New Haven, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Bucala
authors.affiliation: Department of Rheumatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: Liang-jing
authors.initials: LJ
authors.lastname: Lu
mesh_terms: D018501:Antirheumatic Agents / Q000008:administration & dosage* / Q000191:economics* / Q000600:supply & distribution; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D059451:Biosimilar Pharmaceuticals / Q000008:administration & dosage* / Q000191:economics* / Q000600:supply & distribution; D002681:China; D003198:Computer Simulation; D003362:Cost-Benefit Analysis; D003661:Decision Support Techniques; D004334:Drug Administration Schedule; D016527:Drug Costs; D023381:Endpoint Determination; D000068800:Etanercept; D006295:Health Resources / Q000191:economics* / Q000600:supply & distribution; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D007074:Immunoglobulin G / Q000008:administration & dosage* / Q000191:economics*; D018803:Models, Economic; D018579:Patient Selection; D019057:Quality-Adjusted Life Years; D018124:Receptors, Tumor Necrosis Factor / Q000008:administration & dosage*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D018501:Antirheumatic Agents; D059451:Biosimilar Pharmaceuticals; D007074:Immunoglobulin G; D018124:Receptors, Tumor Necrosis Factor; D000068800:Etanercept