title: Modeling of the clinical and economic impact of a risk-sharing agreement supporting a treat-to-target strategy in the management of patients with rheumatoid arthritis in France.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of a Treat-to-Target strategy with certolizumab pegol in patients with rheumatoid arthritis in the context of a pay-for-performance agreement in which medication costs are refunded in case of discontinuation during the first 3 months of treatment.
  
  
  METHODS
  The Treat-to-Target strategy consisted of a systematic switch to second-line tumor necrosis factor (TNF)α inhibitor in case of an unmet ACR50 response at 3 months compared to current routine clinical practice. A reference cohort treated first-line with certolizumab pegol according to current practice without systematic switching was considered as the comparator. A decision-tree model was constructed to estimate clinical outcome (health assessment questionnaire-disability index or HAQ-DI score), time spent in ACR50 response (ACR 50), and direct costs of treatment over a 2-year period. HAQ scores were derived from American College of Rheumatology 50 (ACR50) responses. All TNFα inhibitors were assumed to have equivalent efficacy and tolerability. Costs were estimated at 2013 French retail prices (date of the pay-for-performance agreement).
  
  
  RESULTS
  The mean duration of an ACR50 response was 1.23 years in the Treat-to-Target strategy certolizumab pegol cohort vs 0.98 years in the reference cohort, resulting in a mean gain in HAQ at 24 months of 0.117. The Treat-to-Target strategy with a mix of TNFα inhibitors as second-line therapy was more expensive than the reference strategy in absolute terms, but this difference was entirely offset by the pay-for-performance agreement. The Treat-to-Target strategy was, thus, cost-neutral over a 2-year period after the payback of CZP cost for patients not achieving the target at 3 months.
  
  
  CONCLUSIONS
  In the context of a pay-for-performance agreement, the management of patients with rheumatoid arthritis using a Treat-to-Target strategy with certolizumab pegol in first line is dominant compared to standard use of this drug in the French setting in 2013.
authors.affiliation: a CEMKA-EVAL , Bourg-la-Reine , France ;
authors.forename: Francis
authors.initials: F
authors.lastname: Fagnani
authors.affiliation: b Université d'Aix Marseille, Service de Rhumatologie, AP-HM Hôpital Sainte-Marguerite , Marseille , France ;
authors.forename: Thao
authors.initials: T
authors.lastname: Pham
authors.affiliation: c AP-HP, Hôpital Henri Mondor, Service de Rhumatologie, and Université Paris Est Créteil, Laboratoire d'Investigation Clinique (LIC) EA4393 , Créteil , France ;
authors.forename: Pascal
authors.initials: P
authors.lastname: Claudepierre
authors.affiliation: d AP-HP Hôpital Saint-Antoine, Service de Rhumatologie and Université Paris VI UPMC-INSERM , Paris , France ;
authors.forename: Francis
authors.initials: F
authors.lastname: Berenbaum
authors.affiliation: e UCB Pharma , Colombes , France ;
authors.forename: Thibault
authors.initials: T
authors.lastname: De Chalus
authors.affiliation: e UCB Pharma , Colombes , France ;
authors.forename: Carine
authors.initials: C
authors.lastname: Saadoun
authors.affiliation: e UCB Pharma , Colombes , France ;
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Joubert
authors.affiliation: f Université Paris 6 - GRC UPMC-08; AP-HP, Service de Rhumatologie, GH Pitié Salpêtrière , Paris , France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
mesh_terms: D018501:Antirheumatic Agents / Q000191:economics* / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy*; D000068582:Certolizumab Pegol / Q000191:economics* / Q000627:therapeutic use*; D003365:Costs and Cost Analysis; D003663:Decision Trees; D005602:France; D006801:Humans; D007345:Insurance Claim Review; D017059:Models, Econometric; D012052:Reimbursement, Incentive / Q000191:economics*; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D000068582:Certolizumab Pegol
keywords: ACR50; Certolizumab pegol; Cost-effectiveness; Pay-for-performance; Rheumatoid arthritis; Risk-sharing; Treat-to-Target strategy