Cost-Effectiveness of Monoclonal Antibodies (MABs) for Rheumatoid Arthritis (RA) in the United States

BACKGROUND: In the last 2 decades, biologics have changed the treatment of RA. The 9 approved MABs on the market have shown improved outcomes. However, these agents created a massive economic burden among U.S. payers. Current methods of cost-containment relegate costs to patients while obstructing clinicians. Pharmacoeconomic analysis is commonly used by payers in decision-making. However, previous cost-effectiveness analyses (CEAs) present varying results with the use of Quality–Adjusted Life Years (QALYs). Therefore, there is a common necessity for a CEA using clinical endpoints in RA.

OBJECTIVES: The objective of this study was to compare the cost-effectiveness of 9 MABs over 12 months from a societal perspective. Efficacy was measured via the percentage of patients achieving an ACR20 and DAS28 less than 2.6.

METHODS: A literature search across PubMed and clinicaltrials.gov was conducted to identify studies. Both direct and indirect costs were compared using a pooled analysis of 30 randomized controlled trials (RCTs). Inputs were modeled for an inpatient hospital setting using the Federal Supply Schedule (FSS). Direct costs included drug price, concomitant medications, health care provider labor costs, and laboratory costs. Indirect costs included absenteeism and presenteeism as related to HAQ-DI and SF-36 PCS scores.

RESULTS: 29 studies were included in the analysis. Across all 9 MABs, over 90% of annual costs were attributed to drug price. Intravenous infliximab was the most cost-effective using ACR20. Concerning DAS28 <2.6, the most cost-effective was subcutaneous tocilizumab. The least cost-effective agent across the board was certolizumab pegol, with adalimumab coming 2nd.

CONCLUSIONS: Although MABs have improved patient outcomes in RA, they present payers with a financial obstacle. These results can benefit payers and clinicians in making value-based decisions for the treatment of RA. As biosimilars enter the market, CEAs for RA will become an essential tool among U.S. payers.