Table 3: Other pharmacoeconomic studies of abatacept in rheumatoid arthritis.

Origin and publication yearType of publicationSourceType of economic evaluationComparing treatmentsResultsComments

US 2012 [40] ReviewPubmedCost of treatmentABA, ADA, CER, ETA, GOL, INF, RTX, TOCIn RA, biologics with the lowest 6-month costs per responder were ADA ($27,853; 95% CI $19,284–40,270), ETA ($29,140; 95% CI $14,170–61,030), and TOC ($31,363; 95% CI $14,713–64,232).Cost per responder was estimated for each biologic as projected per patient drug costs (2011 US$) divided by response rate difference.

US 2011 [41] Research articlePubmedCost of treatmentABA, INF, RTXTotal drug associated costs per surgery visit were $2,828, $1,827, and $6,076; and the costs of IV administration were $224, $171, and $390, respectively, for INF, ABA, and RTX.ABA acquisition and administration costs lower than comparator treatments.

US 2010 [42] Research articlePubmedCUAMTX versus ABA/MTX and RTX/MTXICER per QALY: $47,191 for ABA/MTX and $54,891 for RTX/MTX versus MTX alone.Third party payer perspective. Indirect costs. RTX dominated by ABA.

Canada 2012 [7]Research articlePubmedCEAABA versus sequential use of anti-TNF agentsAs first biologic agent, ABA appears significantly more cost effective compared to the sequential use of anti-TNF agents ( ). ABA, as second biologic agent, appears significantly more cost effective compared to the sequential use of anti-TNF agents ( ).ABA after failure of DMARDs and after failure of one anti-TNF agent.

US 2008 [43] Research articlePubmedCost analysis relative to QoLABA versus placeboABA led to greater reduction in medical expenditure over time in MTX failure ($152 lower) and anti-TNF failure patients ($122 lower) compared with placebo. Likewise, significantly more reduction in likelihood for current and future job loss was achieved with ABA.Two RCTs. One with patients who have not responded to MTX and the other with patients unresponsive to anti-TNF agents.

US 2008 [44] Research articlePubmedCost analysis relative to lost productivityABA versus no treatmentThe lost productivity cost of RA for a firm of 10,000 was $1.69 million. In the base case analysis 37% of the acquisition cost of abatacept was offset by reductions in the cost of RA-related productivity losses. In some industry groups (Utilities and Finance) and in models that included presenteeism, reductions in lost productivity costs exceeded the abatacept cost.Productivity losses for a private firm of 10,000 due to employee absences and reduced effectiveness at work because of rheumatoid arthritis.

Canada 2008 [45] Poster abstractISPORCEAABA versus MTX, DMARDs, placebo, INF(1) AIM: on a lifetime basis, ABA was estimated to yield an average of 1.4 additional QALYs per patient versus MTX at a mean incremental cost of $54,331; the estimated CE of ABA was $39,604 per QALY gained.
(2) ATTAIN: ABA yielded an average of 1.2 additional QALY versus oral DMARDs alone at a mean incremental cost of $50,141; estimated CE of ABA was $42,021per QALY. (3) Trial 043: relative to placebo, ABA yielded an average of 1.58 additional QALY at ICER of $58,351. ICER of ABA was $37,094 per QALY; INF yielded an average of 1.24 additional QALY at a mean incremental cost of $53,305; incremental CE of INF was $43,247 per QALY. Relative to infliximab, the incremental CE of ABA was about $14,841 per QALY.
Active RA and failure to MTX or anti-TNF.
Simulation model to depict progression of functional disability over time. Functional disability was expressed in terms of HAQ-DI. The model separately estimated CE using data from three phase III clinical trials ABA is cost effective in patients with active RA and inadequate response to DMARD or anti-TNF therapy and also highly cost effective relative to INF.

Italy 2011 [46] Poster abstractISPORBIAThe sequence including ABA (ABA-IFX-RTX) as first line was compared with: ETN-IFX-RTX; ADA-IFX-RTXItalian target population was estimated in about 7000 RA patients. At the end of the third year patients still on first biologic drug were 5670, 4610, and 4680 in the sequence with ABA, ETN, and ADA. Patients in ACR I or II were 6240, 6160, and 6000, respectively. The annual cost at the third year was 47.0 million, 48.5 million, and 47.8 million for the sequence with ABA, ETA, and ADA, respectively.The use of ABA as first biologic line treatment for RA showed to provide better control of the disease along with a positive impact in total costs, when compared with traditional sequences based on anti-TNFa in Italy.

Brazil 2009 [47] Poster abstractISPORBIAAll 1st line biologic therapiesTotal annual costs were $Brz81,021 for TOC, $Brz92,789 for ETA, $Brz98,541 for ADA, $Brz105,283 for INF, and $Brz85,020 for ABA. Based on the change in the forecast, total savings for a period of 5 years were $Brz1,573,902 for each 100 treated patients, when comparing the group of patients received TOC to the group of patients that did not receive TOC. Findings suggest TOC offers potential costs reductions in the private healthcare system in Brazil.

Brazil 2009 [48] Poster abstractISPORBIAAll 1st line biologic therapiesTotal annual costs were $Brz47,566 for TOC, $Brz50,785 for ETA, $Brz53,909 for ADA, $Brz58.603 for INF and $Brz50,048 for ABA. Based on the change in the mix of treatment forecast, total savings for a period of 5 years were $Brz674.527 for each 100 treated patients, when comparing the group of patients that received TOC to the group of patients that did not receive TOC. Findings suggest TOC has the potential to offer costs reductions in the public healthcare system in Brazil.

Brazil 2008 [49] Poster abstractISPORBIAABA versus current practiceIn the first year of inclusion there is an increase in costs of R$3,085,711 (US$1,763,263). In the second and third years there are significant savings on budgets, R$97,593,971 (US$55,767,983) and R$129,458,357 (US$73,976,204), respectively. The incorporation of ABA into the NPEM is cost saving to the Brazilian Public Health System, saving R$129,458,357.00 (US$73,976,204) after the third year.

USA 2008 [50] Poster abstractISPORCost of treatmentABA versus INFThe estimated annual drug plus infusion administration cost of first and subsequent biologic therapy was $13,354 and $14,465 for ABA and $16,608 and $23,913 for INF, respectively.Patients treated with INF experienced an increase in dosage and/or dosing frequency, resulting in an increase in real world treatment costs. Patients treated with ABA showed no considerable increase in dose or dosing frequency from first to last infusion.