title: Pharmacoeconomic analysis of biological disease modifying antirheumatic drugs in patients with rheumatoid arthritis based on real-world data from the IORRA observational cohort study in Japan.
abstract: OBJECTIVE
  To evaluate the cost-effectiveness of biological disease modifying antirheumatic drugs (bDMARDs) in patients with rheumatoid arthritis (RA) in a real-world setting in Japan.
  
  
  METHODS
  We used a state-transition model and parameters were determined from RA patients registered in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort study on 421 patients who had failed at least one DMARD and started either 1 of 4 bDMARDs (bDMARD group; adalimumab, etanercept, infliximab, and tocilizumab) or methotrexate (control group). bDMARD group was evaluated as two groups: sequence of any 1 of 4 bDMARDs with and without tocilizumab. The incremental cost-effectiveness ratios (ICERs) for bDMARD group were estimated using base-case analysis, probabilistic sensitivity analysis (PSA) and scenario sensitivity analyses.
  
  
  RESULTS
  ICERs of bDMARD group with or without tocilizumab were $38,179 and $48,855, respectively. By PSA, these sequences had respective probabilities of 86.8% and 75.1% of falling below the assumed cost-effectiveness threshold of $50,000 in Japan. Scenario sensitivity analyses showed that the best population for initiating bDMARD was RA patients less than 50 years old with Japanese version of HAQ between 1.1 and 1.6 and using tocilizumab as the bDMARD.
  
  
  CONCLUSIONS
  bDMARDs were cost-effective for RA patients based on a real-world setting in Japan.
authors.affiliation: a Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.affiliation: a Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Eisuke
authors.initials: E
authors.lastname: Inoue
authors.affiliation: a Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Rei
authors.initials: R
authors.lastname: Yamaguchi
authors.affiliation: a Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Shimizu
authors.affiliation: a Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Kobayashi
authors.affiliation: a Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Sugimoto
authors.affiliation: a Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Hoshi
authors.affiliation: a Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Kumi
authors.initials: K
authors.lastname: Shidara
authors.affiliation: a Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Eri
authors.initials: E
authors.lastname: Sato
authors.affiliation: a Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Seto
authors.affiliation: a Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Nakajima
authors.affiliation: a Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Momohara
authors.affiliation: a Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Taniguchi
authors.affiliation: a Institute of Rheumatology, Tokyo Women's Medical University , Tokyo , Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Yamanaka
mesh_terms: D000068879:Adalimumab / Q000191:economics / Q000627:therapeutic use; D000328:Adult; 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; D017850:Economics, Pharmaceutical; D000068800:Etanercept / Q000191:economics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000069285:Infliximab / Q000191:economics / Q000627:therapeutic use; D007564:Japan; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D008962:Models, Theoretical; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D018501:Antirheumatic Agents; D000069285:Infliximab; D000068879:Adalimumab; C502936:tocilizumab; D000068800:Etanercept; D008727:Methotrexate
keywords: Biological disease modifying antirheumatic drugs; Cost-effectiveness; Quality-adjusted life years; Rheumatoid arthritis; Tocilizumab