COST-EFFECTIVENESS OF TAPERING BIOLOGICS IN RHEUMATOID ARTHRITIS PATIENTS: A REAL-WORLD, MULTICENTER COHORT STUDY
Author(s)
Luuk van Esveld1, Ezra Parsan, MD2, Marie-Luise Oudemans, MD PhD3, Amin Herman, MD4, Tessa M Bosch, PharmD PhD2, Martijn Kuijper, PhD5, Mariska Quirina Nikita Hackert, PhD2, Angelique Weel-Koenders, MSc, PhD, MD6.
1Researcher, Maasstad Ziekenhuis, Utrecht, Netherlands, 2Maasstad Ziekenhuis, Rotterdam, Netherlands, 3Martini Ziekenhuis, Groningen, Netherlands, 4Sint Antoniusziekenhuis, Nieuwegein, Netherlands, 5Maasstad Hospital, Rotterdam, Netherlands, 6Erasmus University & Maasstad Hospital, Rotterdam, Netherlands.
1Researcher, Maasstad Ziekenhuis, Utrecht, Netherlands, 2Maasstad Ziekenhuis, Rotterdam, Netherlands, 3Martini Ziekenhuis, Groningen, Netherlands, 4Sint Antoniusziekenhuis, Nieuwegein, Netherlands, 5Maasstad Hospital, Rotterdam, Netherlands, 6Erasmus University & Maasstad Hospital, Rotterdam, Netherlands.
OBJECTIVES: Rheumatoid arthritis (RA) imposes a substantial clinical and economic burden. Although tapering biologic disease-modifying antirheumatic drugs (bDMARDs) is recommended in patients with sustained low disease activity (sLDA), uptake in routine care remains limited due to concerns about disease flares and uncertain outcomes. This study aims to evaluate the real‑world cost‑effectiveness of bDMARD tapering compared with continuation in RA patients with sLDA.
METHODS: This real‑world, retrospective, multicenter cohort study was conducted in two Dutch hospitals between 2016 and 2024. Preliminary results are provided in this abstract. Patients were eligible if they had at least two available EQ‑5D measurements, achieved sLDA defined as DAS28<3.2 for at least six months, and had a follow‑up duration of two years. The primary outcome was the incremental cost‑effectiveness ratio (ICER) based on EQ‑5D‑derived quality‑adjusted life years (QALYs). Uncertainty of cost-effectiveness was assessed using probabilistic sensitivity analysis (PSA). Propensity score matching (PSM) was used to adjust for confounding.
RESULTS: Of 748 eligible patients, 189 had sufficient data to be included in this preliminary analysis. Baseline characteristics were largely comparable between the tapering and continuation groups, although the tapering group demonstrated a slightly higher median EQ‑5D score at baseline (0.81 vs 0.75; p=0.012). Over two years of follow-up, tapering yielded average cost savings of €1,943 and a QALY gain of 0.194 compared to continuation of bDMARDs (ICER = -€10,023 per QALY gained). PSA demonstrated a 98.8% probability that tapering was cost‑effective compared with continuation at a willingness-to-pay threshold of €20,000 per QALY gained.
CONCLUSIONS: Preliminary results suggest that tapering biologics in clinical practice among RA patients with sLDA is likely to be cost-effective. However, inclusion of a third hospital and adjustment for immortal time bias may modestly affect these findings. With variability in (cost-)effectiveness persisting, future research into predictive models may guide personalized tapering decisions.
METHODS: This real‑world, retrospective, multicenter cohort study was conducted in two Dutch hospitals between 2016 and 2024. Preliminary results are provided in this abstract. Patients were eligible if they had at least two available EQ‑5D measurements, achieved sLDA defined as DAS28<3.2 for at least six months, and had a follow‑up duration of two years. The primary outcome was the incremental cost‑effectiveness ratio (ICER) based on EQ‑5D‑derived quality‑adjusted life years (QALYs). Uncertainty of cost-effectiveness was assessed using probabilistic sensitivity analysis (PSA). Propensity score matching (PSM) was used to adjust for confounding.
RESULTS: Of 748 eligible patients, 189 had sufficient data to be included in this preliminary analysis. Baseline characteristics were largely comparable between the tapering and continuation groups, although the tapering group demonstrated a slightly higher median EQ‑5D score at baseline (0.81 vs 0.75; p=0.012). Over two years of follow-up, tapering yielded average cost savings of €1,943 and a QALY gain of 0.194 compared to continuation of bDMARDs (ICER = -€10,023 per QALY gained). PSA demonstrated a 98.8% probability that tapering was cost‑effective compared with continuation at a willingness-to-pay threshold of €20,000 per QALY gained.
CONCLUSIONS: Preliminary results suggest that tapering biologics in clinical practice among RA patients with sLDA is likely to be cost-effective. However, inclusion of a third hospital and adjustment for immortal time bias may modestly affect these findings. With variability in (cost-)effectiveness persisting, future research into predictive models may guide personalized tapering decisions.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE196
Topic
Economic Evaluation, Real World Data & Information Systems
Disease
Biologics & Biosimilars, Musculoskeletal Disorders (Arthritis, Bone Disorders, Osteoporosis, Other Musculoskeletal)