title: Cost-effectiveness of tocilizumab, a humanized anti-interleukin-6 receptor monoclonal antibody, versus methotrexate in patients with rheumatoid arthritis using real-world data from the IORRA observational cohort study.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of tocilizumab in patients with rheumatoid arthritis (RA) in a real-world setting in Japan.
  
  
  METHODS
  The cost-effectiveness was determined using a Markov model-based probabilistic simulation. Data from RA patients registered in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort study between April 2007 and April 2011 were extracted using a pair-matching method: tocilizumab group (n = 104), patients who used at least 1 disease-modifying anti- rheumatic drug and in whom tocilizumab treatment was initiated; methotrexate group (n = 104), patients in whom methotrexate treatment was initiated for the first time or after an interruption of 6 or more months. Assuming a 6-month cycle length, health benefits and costs were measured over a lifetime and discounted at an annual rate of 3%.
  
  
  RESULTS
  Compared with methotrexate treatment, lifetime costs and quality-adjusted life years (QALYs) for tocilizumab treatment were approximately 1.5- and 1.3-times higher, respectively. Incremental cost per QALY gained with tocilizumab was $49,359, which was below the assumed cost-effectiveness threshold of $50,000 per QALY. The probability of tocilizumab being cost- effective was 62.2%.
  
  
  CONCLUSIONS
  The simulation model using real-world data from Japan showed that tocilizumab (at a certain price) may improve treatment cost-effectiveness in patients with moderate-to-severe RA by enhancing quality-adjusted life expectancy.
authors.affiliation: Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Eisuke
authors.initials: E
authors.lastname: Inoue
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hoshi
authors.forename: Yoko
authors.initials: Y
authors.lastname: Shimizu
authors.forename: Akiko
authors.initials: A
authors.lastname: Kobayashi
authors.forename: Naoki
authors.initials: N
authors.lastname: Sugimoto
authors.forename: Kumi
authors.initials: K
authors.lastname: Shidara
authors.forename: Eri
authors.initials: E
authors.lastname: Sato
authors.forename: Yohei
authors.initials: Y
authors.lastname: Seto
authors.forename: Ayako
authors.initials: A
authors.lastname: Nakajima
authors.forename: Shigeki
authors.initials: S
authors.lastname: Momohara
authors.forename: Atsuo
authors.initials: A
authors.lastname: Taniguchi
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yamanaka
mesh_terms: D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000191:economics* / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D015331:Cohort Studies; D003362:Cost-Benefit Analysis; D017048:Health Care Costs / Q000639:trends*; D006801:Humans; D007564:Japan; D008297:Male; D008727:Methotrexate / Q000191:economics* / Q000627:therapeutic use; D008875:Middle Aged; D011788:Quality of Life; D019057:Quality-Adjusted Life Years; D019947:Receptors, Interleukin-6 / Q000037:antagonists & inhibitors* / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D019947:Receptors, Interleukin-6; C502936:tocilizumab; D008727:Methotrexate
keywords: Cost-effectiveness; Quality-adjusted life years; Rheumatoid arthritis; Tocilizumab; the Japanese version of the Health Assessment Questionnaire