OBJECTIVES : Systemic idiopathic juvenile arthritis (sJIA) is a subtype of juvenile idiopathic arthritis. Tocilizumab SC is a humanised monoclonal antibody directed against the IL-6 receptor and offers a treatment after the failure of NSAIDs and corticosteroids. The aim of this study is to demonstrate the cost effectiveness of tocilizumab SC compared to anakinra in the treatment of sJIA in line with Turkish cilinical practice.

METHODS : The primary outcome measure of the economic evaluation is chosen as incremental cost per quality adjusted life-years (QALYs) gained. A Markov chain is used to evaluate costs and effectiveness of compared strategies. The model outcomes are evaluated by a cohort analysis which is assumed to start from when patients are 2 years old. Initial CHAQ score was 1,702 and weight was 13,25 kg. The time horizon is 16 years and covers 2-18 years old patients. Health state transitions are evaluated at 12-week time increments and a discount rate of 3,5% is applied for utilities & costs.

Two treatment sequence strategies are compared. Strategy A starts with tocilizumab SC whereas Strategy B starts with anakinra and both strategies continue with etanercept, adalimumab and abatacept respectively. Different scenarios are examined with alternative treatment costs in the one-way deterministic SA and results are validated by PSA including 1.000 simulations.

RESULTS : Tocilizumab SC patients have an average of 5,323 QALY, while the anakinra patients have an average of 4,8185 QALY. The ICER per QALY is found to be 179.053 TRY less in tocilizumab SC treatment strategy compared to anakinra. In alternative scenarios where the age ranges are varied and the price of anakinra was decreased up to 75%, tocilizumab SC is still a very cost effective treatment option.

CONCLUSIONS : In the first-line treatment of sJIA, compared to anakinra, tocilizumab SC is a very cost effective and dominant option when ICER is evaluated.