COMPARISON OF HEALTHCARE COSTS BETWEEN TOCILIZUMAB AND CONVENTIONAL IMMUNOSUPPRESSANTS IN PATIENTS WITH LARGE-VESSEL VASCULITIS: A RETROSPECTIVE STUDY USING CLAIMS DATA IN JAPAN
Author(s)
Koki Nakahara, 1, Sari Horiuchi, BSc1, Takahiko Sugihara, MD, PhD2, Yoshikazu Nakaoka, MD, PhD3, RYOKO SAKAI, PhD, MPH1, Manabu Akazawa, PhD, MPH1.
1Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan, 2Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan, 3Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan.
1Public Health and Epidemiology, Meiji Pharmaceutical University, Tokyo, Japan, 2Division of Rheumatology, Department of Internal Medicine, Toho University School of Medicine, Tokyo, Japan, 3Department of Vascular Physiology, National Cerebral and Cardiovascular Center Research Institute, Osaka, Japan.
OBJECTIVES: Long-term glucocorticoid (GC) therapy is associated with GC-related adverse events (GC-related AEs), leading to treatment discontinuation and increased healthcare expenditures in rheumatic diseases. Although biologics have GC-sparing effects and clinical effectiveness, healthcare cost data remain limited. We compared the cost structures of biologics and conventional therapies to characterize the economic implications of biologics in large-vessel vasculitis (LVV).
METHODS: A retrospective cohort study was conducted using a large-scale hospital claims database (2008-2023). We analyzed patients with LVV, including Takayasu arteritis (TAK) and giant cell arteritis (GCA), who initiated tocilizumab (TCZ) or azathioprine/methotrexate (AZA/MTX) on GC therapy between August 2017 and July 2022. The primary outcome was mean comprehensive disease-related cost (CDRC) per 30 days (€1 = 163.95 JPY). Adjusted cost ratios (aCRs) and 95% CIs were estimated using a generalized linear model, adjusting for baseline patients’ characteristics and pre-index GC dose. We descriptively analyzed daily GC dose, inpatient length of stay (LOS), and high-cost inpatient episodes during follow-up. Analyses were conducted separately for TAK and GCA.
RESULTS: We included 203 patients with TAK (TCZ: n=93; AZA/MTX: n=110) and 368 patients with GCA (TCZ: n=162; AZA/MTX: n=206). CDRC was higher with TCZ than AZA/MTX (TAK: aCR 2.7 [2.0-3.5]; GCA: aCR 3.0 [2.4-3.8]). Drug costs were higher with TCZ (TAK: €709.6 vs. €195.1; GCA: €747.1 vs. €148.4), whereas mean daily GC dose (TAK: 6.4 vs. 6.7 mg/day; GCA: 5.5 vs. 6.9 mg/day) and hospitalization costs (TAK: €36.8 vs. €96.8; GCA: €100.0 vs. €144.3) were lower. Inpatient costs were associated with LOS, and high-cost inpatient episodes frequently involved emergencies or intensive care-related charges.
CONCLUSIONS: In LVV, TCZ showed higher CDRC than AZA/MTX, primarily due to drug costs. However, lower hospitalization costs, mean daily GC doses, and exploratory high-cost inpatient findings suggest potential economic value through shifts in LVV cost structures, including costs potentially associated with GC-related AEs.
METHODS: A retrospective cohort study was conducted using a large-scale hospital claims database (2008-2023). We analyzed patients with LVV, including Takayasu arteritis (TAK) and giant cell arteritis (GCA), who initiated tocilizumab (TCZ) or azathioprine/methotrexate (AZA/MTX) on GC therapy between August 2017 and July 2022. The primary outcome was mean comprehensive disease-related cost (CDRC) per 30 days (€1 = 163.95 JPY). Adjusted cost ratios (aCRs) and 95% CIs were estimated using a generalized linear model, adjusting for baseline patients’ characteristics and pre-index GC dose. We descriptively analyzed daily GC dose, inpatient length of stay (LOS), and high-cost inpatient episodes during follow-up. Analyses were conducted separately for TAK and GCA.
RESULTS: We included 203 patients with TAK (TCZ: n=93; AZA/MTX: n=110) and 368 patients with GCA (TCZ: n=162; AZA/MTX: n=206). CDRC was higher with TCZ than AZA/MTX (TAK: aCR 2.7 [2.0-3.5]; GCA: aCR 3.0 [2.4-3.8]). Drug costs were higher with TCZ (TAK: €709.6 vs. €195.1; GCA: €747.1 vs. €148.4), whereas mean daily GC dose (TAK: 6.4 vs. 6.7 mg/day; GCA: 5.5 vs. 6.9 mg/day) and hospitalization costs (TAK: €36.8 vs. €96.8; GCA: €100.0 vs. €144.3) were lower. Inpatient costs were associated with LOS, and high-cost inpatient episodes frequently involved emergencies or intensive care-related charges.
CONCLUSIONS: In LVV, TCZ showed higher CDRC than AZA/MTX, primarily due to drug costs. However, lower hospitalization costs, mean daily GC doses, and exploratory high-cost inpatient findings suggest potential economic value through shifts in LVV cost structures, including costs potentially associated with GC-related AEs.
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
EE740
Topic
Economic Evaluation, Epidemiology & Public Health
Topic Subcategory
Cost/Cost of Illness/Resource Use Studies
Disease
Biologics & Biosimilars, Cardiovascular Disorders (including MI, Stroke, Circulatory), Rare & Orphan Diseases, Systemic Disorders/Conditions (Anesthesia, Auto-Immune Disorders (n.e.c.), Hematological Disorders (non-oncologic), Pain)