OBJECTIVES: The clinical efficacy of biologic/targeted synthetic/biosimilar disease modifying antirheumatic drugs (b/ts/biosimilar DMARDs) in treating inflammatory arthritis is well documented, while the economic performance of these agents remains vague. This systematic review aims to identify the updated evidence of b/ts/biosimilar DMARDs cost-effectiveness in the management of inflammatory arthritis to inform prescribing and formulary listing decisions.

METHODS: We conducted a systematic review on cost-effectiveness of b/ts/biosimilar DMARDs in treating inflammatory arthritis through five databases. We summarized the cost-effectiveness results comparing b/ts/biosimilar DMARDs versus conventional synthetic DMARDs (csDMARDs). We then conducted secondary analysis on extracted data to calculate the incremental cost-utility ratio (ICUR) to facilitate the comparison among different b/ts/biosimilar DMARDs. We assessed the impact of indirect costs (i.e., non-medical costs incurred due to disease) on ICUR. We also estimated the potential medical cost reduction when using biosimilars.

RESULTS: We identified 58 publications covering four types of inflammatory arthritis: rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, and psoriatic arthritis. For patients with inadequate response to csDMARDs, less than half of the comparisons concluded that b/ts/biosimilar DMARDs is cost-effective than csDMARDs, despite the former providing significant improvements on quality-adjusted life-year (QALY). More than 88% of studies reported the new generation b/tsDMARDs have lower costs and comparable QALY gain compared to the old generation. Accounting indirect costs leads to 11.9-60.4% of ICURs reduction. Introducing biosimilar DMARDs is associated with 1.7-16.7% medical costs reduction comparing to their bio-originators.

CONCLUSIONS: B/ts/biosimilar DMARDs are consistently reported with profound QALY improvement and considerable reduction of indirect costs compared to csDMARDs. However, current economic evidence does not fully support the cost-effectiveness of b/ts/biosimilar DMARDs in treating patients with inflammatory arthritis. New generation b/ts/biosimilar DMARDs showed better cost-effectiveness may become favorable in the future market.