Table 1: Cost effectiveness of abatacept versus other therapies in rheumatoid arthritis after failure of conventional DMARDs.

Origin and publication yearType of publicationSourceType of economic evaluationComparing treatmentsResultsComments

USA 2008 [10] Research articlePubmedCEAMTX versus MTX and ABAICER per QALY. Over a decade $47,910. Over a lifetime $43,041Moderate to severe active RA after inadequate response to MTX.

Brazil 2008 [11] Poster abstractISPORCEAABA versus MTXOver the lifetime, ABA therapy was estimated to yield an average of 1.61 additional QALYs per patient (versus MTX alone) at a mean incremental cost of R$146.095/QALY (US$83,483, US$1 = R$1.75).Moderate to severe active RA after inadequate response to MTX.

Colombia 2009 [12] Poster abstractISPORCEA
BIA
ABA versus TOCA hypothetical cohort of 1,000 patients with RA-IR MTX followed for 20 years or until death, the mean direct medical costs per patient for ABA were U$132,654 (129,198–145,203), compared to U$283,753 (275,809–315,551) for TOC. For the group of subjects treated with ABA, 84% of these costs were associated with the drug; for TOC, 93% of the costs are associated with the drug. The mean numbers of life years were 29.27 (28.45–30.15) and 29.25 (28.43–30.13) for ABA and TOC, respectively. The mean numbers of QALYs (discounted) by ABA and TOC were 7.21 (7.02–7.42), and 7.15 (6.96–7.37), respectively.After inadequate response to MTX, using ABA as the reference treatment, TOC provided less utility at a higher cost, being dominated by ABA.

Venezuela 2011 [13] Poster abstractISPORCEA
BIA
ABA versus INFA hypothetical cohort of 1,000 patients with RA and IR MTX in Venezuela, followed for 10 years, resulted in mean treatment costs of U$5,126, U$57,824, and U$27,842 dollars, for MTX, ABA, and INF, respectively. Total direct medical costs (discounted) per patient were U$50,441 (48,819–52,448) for MTX, U$93,992 (89,366–98,982) for ABA, and $73,100 (68,539–81,877) for INF. The total QALYs gained (discounted) by MTX, ABA, and INF during the same period were 2.96 (2.89–3.03), 4.05 (3.85–4.30) and 3.26 (3.16–3.39), respectively. The Incremental Cost-Effectiveness Ratio was U$39,980 (36,649–45,011) for ABA compared to MTX compared to U$77,790 (62,369–98,124) per QALY gained with INF.The use of ABA is more cost-effective than the use of INF, both compared to MTX, in patients with RA with IR MTX in Venezuela.

Peru 2011 [14] Poster abstractISPORCEA
ABA versus other biologic DMARDsThe cost of treatment with ABA resulted in S/. 169 263 and its effectiveness was found to be 1.96 QALY. Regarding ETA, ADA, INF, and TOC, ABA was shown to be the most effective in terms of QALYs and the least expensive. Regarding RTX, ABA has an incremental cost effectiveness ratio of S/. 75 493 per QALY gained.ABA was found to be dominant against ETA, ADA, INF, TOC, from the Health Social Security (EsSalud) perspective for the treatment of moderate to severe active RA after IR to MTX.

Colombia 2011 [15] Poster abstractISPORCEA
BIA
ABA versus INFIn a hypothetical cohort of 1,000 patients with RA-IR MTX, the costs of treatment for the first year for MTX were U$794 dollars, compared to U$16,659 for ABA and U$17,531 for INF, assuming dosages for average patients below 60 kg. Additional analysis with patients over 60 kg was included in the sensitivity analysis. After 10 years of followup the discounted total direct medical costs per patient were U$55,998 (54,354–57,776) for MTX, U$99,888 (94,694–104,437) for ABA, and $79,174 (75,795–83,899) for INF. The total numbers of QALYs gained (discounted) by MTX, ABA, and INF were 2.88 (2.79–2.95), 3.94 (3.79–4.09), and 3.17 (3.09–3.27), respectively. The calculated ICERs for ABA and INF compared to MTX were U$37,513 (35,221–39,909) and U$75,873 (62,825–103,132) per QALY gained, respectively. In patients with RA-IR MTX in Colombia, the use of ABA is more cost effective than the use of INF, both compared to MTX.

UK 2010 [16] Poster abstractISPORCEA
ABA with MTX followed by a sequence of DMARDs was compared against a sequence of cDMARDsABA with MTX was estimated to yield 1.09 QALYs per patient (6.42 versus 5.33) over lifetime, compared to DMARDs. The total lifetime costs associated with ABA with MTX were £110,094 and total costs for cDMARDs were £79,933 resulting in an ICER of £27,657 per QALY gained. Sensitivity analysis confirmed the robustness of the model findings.This study has demonstrated that ABA with MTX is a cost effective treatment option compared to cDMARDs for patients with RA after an inadequate response to MTX.

Canada 2010 [17] Poster abstractISPORCEA
MTX versus ABA, ADA, INF, and ETAABA has a cost-effectiveness ratio of approximately $93,000 per QALY gained versus MTX, comparable with those of ETA ($96,000) and ADA ($112,000) and much lower than that of INF ($171,000). At willingness-to-pay between $80,000 and $97,000, ABA is the most cost-effective option. Results were most sensitive to the assumption of the threshold for clinically meaningful HAQ improvement at 6-month and applied time horizon.ABA offers a valuable therapeutic option for the treatment of moderate-to-severe active RA in patients with inadequate response to one or more DMARD therapies.

Italy 2011 [18] Poster abstractISPORCCA
ABA versus INFIn Italy, the annual trial-based costs per remitting/LDAS patient were 70,259/37,219 for ABA versus 85,547/46,592 for INF. In the initiation phase, costs per patient-month in remission/LDAS were 11,028/6,020 for ABA versus 8,347/4,173 for INF. ABA showed lower costs per patient-month in remission/LDAS in the maintenance phase 5,046/2,673 versus 5,500/2,996 for INF. Real-life maintenance costs per month in remission/LDAS were 5,347/2,832 for ABA versus 7,210/3,927 for INF. Higher initiation cost for ABA to achieve remission/LDAS would be offset at 14.6/16.1 months during real life. Findings suggest a lower cost consequence for ABA during the maintenance phase and its real-life extrapolation. ABA is a sustainable, safe, and economically attractive biologic for the long-term treatment of RA when compared to INF.