Economic Evaluation of Synovial Biopsy-Guided Treatment Strategy After TNF-Alpha Inhibitor Failure in Rheumatoid Arthritis
Author(s)
Sainan Chang, MSc1, Felice Rivellese, PhD2, Zoë Ide, MSc1, Anne Barton, PhD1, Katherine Payne, MSc, PhD1, Costantino Pitzalis, PhD2, Sean P. Gavan, PhD1.
1The University of Manchester, Manchester, United Kingdom, 2Queen Mary University of London, London, United Kingdom.
1The University of Manchester, Manchester, United Kingdom, 2Queen Mary University of London, London, United Kingdom.
OBJECTIVES: A phase IV R4RA trial has suggested that patients with a low B cell signature in synovial tissue samples( B cell-poor) responded better to tocilizumab (IL6 targeting) than rituximab (B cell targeting). This study evaluated the indicative cost-effectiveness of using a synovial biopsy to guide second-line biologic treatment for people with RA compared with standard of care in RA.
METHODS: A model-based cost-effectiveness analysis of synovial biopsy-guided treatment compared with the standard of care from the perspective of England healthcare system. For standard of care, patients followed a sequence of treatments (rituximab, tocilizumab, and janus kinase inhibitor). In the biopsy-guided strategy, patients classified as B cell-poor received tocilizumab first, while others followed standard care. A Markov model simulated 1,000 patients per strategy over their lifetime, estimated lifetime costs (£price-year 2024) and quality-adjusted life years (QALYs, EQ-5D-3L UK tariff). Biopsy costs were derived from a micro-costing study. The incremental cost-effectiveness ratio (ICER) was calculated and compared against a threshold of £20,000 per QALY gained. Scenario analyses evaluated the impact of confidential discounts on treatment prices and biopsy cost variations.
RESULTS: Base-case analysis estimated mean lifetime costs of £104,873 per patient for the biopsy-guided group and £104,035 for standard of care (incremental cost of £838). Lifetime QALYs were 5.66 and 5.64 per patient, respectively, gain of 0.015 QALYs. The base-case ICER was £56,463. The estimated ICER reduced to £16,070 assuming a 40% discount to the list price of treatments.
CONCLUSIONS: Second-line selection of biologic treatments informed by synovial tissue biopsy improves lifetime QALYs for RA patients. This strategy is likely to be cost-effective if the biopsy procedure is performed under a best-case scenario (short biopsy duration, low sample analysis cost). Decision-makers can apply this evidence in the context of existing payment agreements to evaluate synovial biopsy cost-effectiveness for their healthcare setting.
METHODS: A model-based cost-effectiveness analysis of synovial biopsy-guided treatment compared with the standard of care from the perspective of England healthcare system. For standard of care, patients followed a sequence of treatments (rituximab, tocilizumab, and janus kinase inhibitor). In the biopsy-guided strategy, patients classified as B cell-poor received tocilizumab first, while others followed standard care. A Markov model simulated 1,000 patients per strategy over their lifetime, estimated lifetime costs (£price-year 2024) and quality-adjusted life years (QALYs, EQ-5D-3L UK tariff). Biopsy costs were derived from a micro-costing study. The incremental cost-effectiveness ratio (ICER) was calculated and compared against a threshold of £20,000 per QALY gained. Scenario analyses evaluated the impact of confidential discounts on treatment prices and biopsy cost variations.
RESULTS: Base-case analysis estimated mean lifetime costs of £104,873 per patient for the biopsy-guided group and £104,035 for standard of care (incremental cost of £838). Lifetime QALYs were 5.66 and 5.64 per patient, respectively, gain of 0.015 QALYs. The base-case ICER was £56,463. The estimated ICER reduced to £16,070 assuming a 40% discount to the list price of treatments.
CONCLUSIONS: Second-line selection of biologic treatments informed by synovial tissue biopsy improves lifetime QALYs for RA patients. This strategy is likely to be cost-effective if the biopsy procedure is performed under a best-case scenario (short biopsy duration, low sample analysis cost). Decision-makers can apply this evidence in the context of existing payment agreements to evaluate synovial biopsy cost-effectiveness for their healthcare setting.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EE386
Topic
Economic Evaluation
Topic Subcategory
Value of Information
Disease
Biologics & Biosimilars, Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal), Personalized & Precision Medicine