title: Cost-effectiveness analysis of two rituximab retreatment regimens for longstanding rheumatoid arthritis.
abstract: OBJECTIVE
  Rituximab (RTX) is licensed for second-line treatment of rheumatoid arthritis (RA) after first tumor necrosis factor (TNF) inhibitor failure. RTX is generally administered intravenously at 1 gm 2 weeks apart, and the retreatment is scheduled at the time of clinical relapse (regimen 1). A more intensive regimen is proposed with a fixed full cycle after 6 months (regimen 2) if remission is not reached. A cost-effectiveness analysis (CEA) compared these 2 regimens of RTX administration in patients with longstanding RA based on data provided by an observational study.
  
  
  METHODS
  An observational retrospective study was conducted on 102 patients, enrolled in 3 hospitals and followed for ≥12 months. Forty-seven patients followed regimen 1, while 55 patients followed regimen 2. A CEA based on a Markov model was conducted. A lifelong and social perspective was adopted. CEA was conducted for the entire cohort and for the 2 subgroups separately (patients with positive rheumatoid factor and/or anti-cyclic citrullinated peptide and failures to TNF inhibitors).
  
  
  RESULTS
  Results for the overall sample show at 10, 20, and 30 years that regimen 1 is less costly and associated with a higher quality of life compared to regimen 2. Probabilistic sensitivity analysis at 10 years estimated a probability of 95.1% for regimen 1 to be cost effective given a willingness to pay of €35,000/quality-adjusted life year, while for seropositive patients and for TNF failures it was estimated to be 92% and 92.7%, respectively.
  
  
  CONCLUSIONS
  In longstanding RA, cost effectiveness of RTX retreatment at clinical relapse was found to be at least equivalent to the more intensive regimen proposed.
authors.affiliation: University Hospital Santa Maria della Misericordia, Udine, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Quartuccio
authors.affiliation: A. Gemelli Teaching Hospital, Rome, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: di Bidino
authors.affiliation: Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ruggeri
authors.affiliation: University of Padua, Padua, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Schiavon
authors.affiliation: University of Verona, Verona, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Biasi
authors.affiliation: University of Verona, Verona, Italy.
authors.forename: Silvano
authors.initials: S
authors.lastname: Adami
authors.affiliation: University of Padua, Padua, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Punzi
authors.affiliation: Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: Americo
authors.initials: A
authors.lastname: Cicchetti
authors.affiliation: University Hospital Santa Maria della Misericordia, Udine, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: de Vita
mesh_terms: D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000191:economics*; D018501:Antirheumatic Agents / Q000008:administration & dosage / Q000191:economics*; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics*; D003362:Cost-Benefit Analysis / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019233:Retreatment / Q000191:economics / Q000379:methods; D012189:Retrospective Studies; D000069283:Rituximab; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D018501:Antirheumatic Agents; D000069283:Rituximab