Cost-Effectiveness Modelling of Sequential Biologic Strategies for the Treatment of Moderate to Severe Rheumatoid Arthritis in Finland

Abstract: Objective: The main objective was to compare the cost-effectiveness of therapeutic options in moderate or severe rheumatoid arthritis (RA) when a clinical response to a first TNF-blocker, either etanercept (ETA), adalimumab (ADA), or infliximab (INF), is insufficient. Methods: Effectiveness criteria were defined as remission (RS), low disease activity (LDAS), and moderate to high disease activity (MHDAS). Cost-effectiveness was derived as cost per day in RS and in LDAS using simulation modelling to assess six sequential biologic strategies over 2 years. Each sequential treatment strategy was composed of three biologic agents and included a first anti-TNF agent, ETA, ADA or INF, followed by either abatacept (ABA) or rituximab (RTX) as a second therapeutic option in case of an insufficient response, followed by another anti-TNF agent in case of further insufficient response. Results: Over two years and taking into account biologic costs, the following estimated mean costs per day in RS and LDAS were respectively of �829 and �428 for the biologic sequence composed of ADA-ABA-ETA, �1292 and �516 for the sequence ADA-RTX-ETA, �829 and �429 for the sequence ETA-ABA-ADA, �1292 and �517 for the sequence ETA-RTX-ADA, �840 and �434 for the sequence INF-ABA-ETA, and �1309 and �523 for the sequence INF-RTX-ETA. Conclusion: The treatment sequences including ABA as the second biologic option appear more cost-effective than those including RTX in a patients with moderate to severe RA and an insufficient response to a first anti-TNF agent. Keywords: Cost-effectiveness, rheumatoid arthritis, biologics, modelling

Cost–utility of different treatment strategies after the failure of tumour necrosis factor inhibitor in rheumatoid arthritis in the Finnish setting

Objective. To evaluate the cost–utility of different treatment strategies in severe RA after TNF-inhibitor failure

No improvement in long-term wear and revision rates with the second-generation Biomet cup (RingLoc) in young patients: 141 hips followed for median 12 years

Optimising joint reconstruction management in arthritis and bone tumour patient

Cost-effectiveness of abatacept, tocilizumab and TNF-inhibitors compared with rituximab as second-line biologic drug in rheumatoid arthritis

Objectives: The objective of this study was to evaluate the cost-effectiveness of abatacept, tocilizumab, and tumor necrosis factor (TNF) inhibitors as compared with rituximab in Finnish rheumatoid arthritis patients, who have previously been treated with TNF inhibitors.Methods: A patient-level simulation model was developed to predict costs and outcomes associated with four biological drugs (abatacept, tocilizumab, rituximab and TNF inhibitors) in the treatment of rheumatoid arthritis. Following lack of efficacy or adverse events, the patients were switched to another biological drug until all four options were exhausted. After that, the patients were assumed to receive a 6th line treatment until death. The patients' baseline characteristics and regression models used in the simulation were based on observational data from the National Register for Biological Treatments in Finland. Direct costs comprised drug costs, administration costs, costs of switching, and outpatient and inpatient care, while indirect costs included disability pension and sick leaves due to rheumatoid arthritis. Several subgroup and deterministic sensitivity analyses were conducted.Results: Drug costs were the lowest for rituximab, but when administration costs and costs of switching were included, drug costs were the lowest for TNF inhibitors. Abatacept was associated with the highest drug costs, whereas rituximab was associated with the highest healthcare costs. In total, TNF inhibitors had the lowest direct costs, while rituximab had the highest direct costs. The amount of quality-adjusted life years (QALY) gained ranged from 9.405 for rituximab to 9.661 for TNF inhibitors. TNF inhibitors, abatacept, and tocilizumab were dominant in comparison to RTX.Conclusions: TNF inhibitors, abatacept, and tocilizumab had lower costs and higher QALYs than rituximab, and therefore, they were dominant in comparison to rituximab. As TNF inhibitors had the lowest costs and highest QALYs, they were the most cost-effective treatment option.</div

Automated text message enhanced monitoring versus routine monitoring in early rheumatoid arthritis: a randomized trial

OBJECTIVE:Frequent monitoring of early rheumatoid arthritis (RA) patients is required for achieving good outcomes. We studied the influence of text message (SMS) enhanced monitoring on early RA outcomes.METHODS:We randomized 166 early, disease-modifying antirheumatic drug naive RA patients to SMS-enhanced follow-up or routine care. All patients attended visits at 0, 3, and 6 months, and a follow-up visit at 12 months. Treatment was at the physicians' discretion. The intervention included 13 SMSs during weeks 0-24 with questions concerning medication problems (yes/no) and disease activity (patient global assessment [PGA], scale 0-10). If response SMSs indicated medication problems or PGA exceeded predefined thresholds the patients were contacted. Primary outcome was 6-month Boolean remission (no swollen or tender joints, normal CRP). Quality of life (QOL, Short Form 36) and 28-joint disease activity scores (DAS28) were assessed.RESULTS:Six and 12-month follow-up data were available for 162 and 157 patients. In the intervention group, 47% (38/82) of the patients reported medication problems and 49% (40/82) of the patients reported SMS-PGAs above the alarm limit. Remission rates in the intervention and control groups were 51% and 42% at 6 months (p=0.34); and 57% and 43% at 12 months (p=0.17). The respective DAS28 scores were 1.92±1.12 and 2.22±1.11 at 6 months (p=0.09); and 1.79±0.91 and 2.08±1.22 at 12 months (p=0.28). No differences in QOL were observed.CONCLUSION:The study failed the primary outcome despite a trend favoring the intervention group. This may be explained by the notably high overall remission rates. This article is protected by copyright. All rights reserved.</p