A COST-UTILITY ANALYSIS OF TOCILIZUMAB PLUS METHOTREXATE VERSUS METHOTREXATE ALONEIN RHEUMATOID ARTHRITIS IN INDIA, USING THE MARKOV STATE TRANSITION MODEL
Author(s)
Norah E. Shynu, PharmD1, Shruthi Ashok Kumar, PharmD1, Adusumilli Pramod Kumar, PhD2, JEESA GEORGE, Mpharm2;
1M S Ramaiah University Of Applied Sciences, Bengaluru, India, 2M S Ramaiah University Of Applied Sciences, Bangalore, India
1M S Ramaiah University Of Applied Sciences, Bengaluru, India, 2M S Ramaiah University Of Applied Sciences, Bangalore, India
OBJECTIVES: Rheumatoid arthritis is a chronic autoimmune disease characterized by the progressive loss of function and a decreased quality of life. The objective of this study is to analyse the cost-effectiveness of the combination of Tocilizumab and Methotrexate (MTX), compared to Methotrexate alone. The study is conducted from healthcare payer's perspective.
METHODS: An individual state transition simulation model using the Markov process was developed to reflect disease development in RA patients. It includes five health states, with death as the absorbing state, and is divided by Health Assessment Questionnaire scores. Transition probabilities, treatment costs, and utility values were taken from the literature. Outcomes were measured by quality-adjusted life-years (QALYs), and the cost is presented in local currency units of India. Probabilistic sensitivity analysis was used to examine the uncertainty of the parameters used in this cost-effectiveness analysis, and results were evaluated using the threshold of willingness to pay.
RESULTS: MTX monotherapy (Treatment A) had an overall cost of 58,032 rupees and created an outcome of 13.18 QALYs. Tocilizumab and Methotrexate combined (Treatment B) had an overall cost of 18,03,468 rupees and an outcome of 13.45 QALYs. The incremental cost-effectiveness ratio (ICER) at this stage was 64,71,806 rupees per QALY, which reveals that while the regime has additional benefits, the additional cost incurred is significantly high. Results were validated by the PSA.
CONCLUSIONS: From the perspective of a healthcare payer, the improvement contributed by Tocilizumab, as an add-on treatment with Methotrexate, is relatively small compared to the outcome achieved by using only Methotrexate. This finding is significant from the perspective of making economic decisions, as it serves as an important point to which policymakers must give attention when making decisions concerning the treatment of Rheumatoid Arthritis.
METHODS: An individual state transition simulation model using the Markov process was developed to reflect disease development in RA patients. It includes five health states, with death as the absorbing state, and is divided by Health Assessment Questionnaire scores. Transition probabilities, treatment costs, and utility values were taken from the literature. Outcomes were measured by quality-adjusted life-years (QALYs), and the cost is presented in local currency units of India. Probabilistic sensitivity analysis was used to examine the uncertainty of the parameters used in this cost-effectiveness analysis, and results were evaluated using the threshold of willingness to pay.
RESULTS: MTX monotherapy (Treatment A) had an overall cost of 58,032 rupees and created an outcome of 13.18 QALYs. Tocilizumab and Methotrexate combined (Treatment B) had an overall cost of 18,03,468 rupees and an outcome of 13.45 QALYs. The incremental cost-effectiveness ratio (ICER) at this stage was 64,71,806 rupees per QALY, which reveals that while the regime has additional benefits, the additional cost incurred is significantly high. Results were validated by the PSA.
CONCLUSIONS: From the perspective of a healthcare payer, the improvement contributed by Tocilizumab, as an add-on treatment with Methotrexate, is relatively small compared to the outcome achieved by using only Methotrexate. This finding is significant from the perspective of making economic decisions, as it serves as an important point to which policymakers must give attention when making decisions concerning the treatment of Rheumatoid Arthritis.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
EE451
Topic
Economic Evaluation
Disease
No Additional Disease & Conditions/Specialized Treatment Areas, SDC: Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), STA: Alternative Medicine