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International Journal of Inflammation
Volume 2011, Article ID 727634, 9 pages
Research Article

Modelling Cost-Effectiveness of Biologic Treatments Based on Disease Activity Scores for the Management of Rheumatoid Arthritis in Spain

1R&D, Data Mining International, 1215 Geneva, Switzerland
2LIRAES, Paris Descartes University, 75270 Paris cedex 06, France
3Rheumatology, Hospital Universitario Virgen Macarena, 41007 Sevilla, Spain
4Rheumatology, Hospital de Basurto, 48013 Bilbao, Spain
5Pharmacoeconomics Department, Bristol-Myers Squibb, Iberia, 28040 Madrid, Spain
6Health Economics and Outcomes Strategy, Bristol-Myers Squibb Europe, 1420 Braine-l'Alleud, Belgium

Received 14 February 2011; Accepted 2 May 2011

Academic Editor: B. L. Slomiany

Copyright © 2011 Ariel Beresniak et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. The objective of this simulation model was to assess the cost-effectiveness of different biological treatment strategies based on levels of disease activity in Spain, in patients with moderate to severe active RA and an insufficient response to at least one anti-TNF agent. Methods. Clinically meaningful effectiveness criteria were defined using DAS28 scores: remission and Low Disease Activity State (LDAS) thresholds. Monte-Carlo simulations were conducted to assess cost-effectiveness over 2 years of four biological sequential strategies composed of anti-TNF agents (adalimumab, infliximab), abatacept or rituximab, in patients with moderate to severe active RA and an insufficient response to etanercept as first biological agent. Results. The sequential strategy including etanercept, abatacept and adalimumab appeared more efficacious over 2 years (102 days in LDAS) compared to the same sequence including rituximab as second biological option (82 days in LDAS). Cost-effectiveness ratios showed lower costs per day in LDAS with abatacept (427 €) compared to rituximab as second biological option (508 €). All comparisons were confirmed when using remission criteria. Conclusion. Model results suggest that in patients with an insufficient response to anti-TNF agents, the biological sequences including abatacept appear more efficacious and cost-effective than similar sequences including rituximab or cycled anti-TNF agents.