title: Rituximab as first choice for patients with refractory rheumatoid arthritis: cost-effectiveness analysis in Iran based on a systematic review and meta-analysis.
abstract: The aim of this study was to evaluate the effectiveness and cost-effectiveness of using rituximab as first line for patients with refractory rheumatoid arthritis in comparison with continuing conventional DMARDs, from a perspective of health service governors. A systematic review was implemented through searching PubMed, Scopus and Cochrane Library. Quality assessment was performed by Jadad scale. After meta-analysis of ACR index results, QALY gain was calculated through mapping ACR index to HAQ and utility index. To measure the direct and indirect medical costs, a set of interviews with patients were applied. Thirty-two patients were selected from three referral rheumatology clinics in Tehran with definite diagnosis of refractory rheumatoid arthritis in the year before and treatment regimen of either rituximab or DMARDs within last year. Incremental cost-effectiveness ratio was calculated for base case and scenario of generic rituximab. Threefold of GDP per capita was considered as threshold of cost-effectiveness. Four studies were eligible to be considered in this systematic review. Total risk differences of 0.3 for achieving ACR20 criteria, 0.21 for ACR50 and 0.1 for ACR70 were calculated. Also mean of total medical costs of patients for 24 weeks were $3985 in rituximab group and $932 for DMARDs group. Thus, the incremental cost per QALY ratio will be $45,900-$70,223 in base case and $32,386-$49,550 for generic scenario. Rituximab for treatment of patients with refractory rheumatoid arthritis is not considered as cost-effective in Iran in none of the scenarios.
authors.affiliation: Department of Pharmacoeconomics and Pharmaceutical Administration, and Pharmaceutical Policy Research Center, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Saeed
authors.initials: S
authors.lastname: Ahmadiani
authors.affiliation: Department of Pharmacoeconomics and Pharmaceutical Administration, and Pharmaceutical Policy Research Center, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. nikfar_sh@razi.tums.ac.ir.|Iran Food and Drug Administration, Fakhre-Razi St., Enghelab St, Tehran, Iran. nikfar_sh@razi.tums.ac.ir.
authors.forename: Shekoufeh
authors.initials: S
authors.lastname: Nikfar
authors.affiliation: Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Somayeh
authors.initials: S
authors.lastname: Karimi
authors.affiliation: Rheumatology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ahmad Reza
authors.initials: AR
authors.lastname: Jamshidi
authors.affiliation: Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Akbari-Sari
authors.affiliation: Department of Pharmacoeconomics and Pharmaceutical Administration, and Pharmaceutical Policy Research Center, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Kebriaeezadeh
mesh_terms: D018501:Antirheumatic Agents / Q000191:economics / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy* / Q000191:economics; D003362:Cost-Benefit Analysis; D006801:Humans; D007492:Iran; D000069283:Rituximab / Q000191:economics / Q000627:therapeutic use*
chemical_list: D018501:Antirheumatic Agents; D000069283:Rituximab
keywords: Cost-effectiveness; Iran; Rheumatoid arthritis; Rituximab