DISCONTINUATION PLAYS A ROLE WHEN EVALUATING THE COST EFFECTIVENESS OF THE SECOND BIOLOGICAL DRUG FOR PATIENTS WITH RHEUMATOID ARTHRITIS

Author(s)

Karpes Matusevich A1, Rasu R2, Lal L3, Wenyaw C1, Swint JM1, Cantor SB4, Suarez-Almazor ME4, Lopez-Olivo MA4
1University of Texas Health Science Center at Houston - School of Public Health, Houston, TX, USA, 2University of North Texas Health Science Center, Fort Worth, TX, USA, 3University of Texas Health Science Center at Houston - School of Public Health, Missouri City, TX, USA, 4University of Texas M.D. Anderson Cancer Center, Houston, TX, USA

OBJECTIVES

Typically, medication adherence calculations include discontinuation when evaluating treatment outcomes. However, most cost-effectiveness analyses of sequences of rheumatoid arthritis(RA) treatment assume that patients will progress through the full sequence (full-sequence model). We aimed to determine if discontinuation of biological treatment (drop-out model) affects the short-term cost-effectiveness of sequences of therapeutic drugs for RA patients after failure of initial tumor necrosis factor inhibitor(TNFi).

METHODS

From the 2008-2016 Truven Health MarketScan Research database, we derived a cohort of patients who failed their first TNFi. We calculated probabilities of switching, continuing or discontinuing therapy and per cycle (6-months) drug-related and other health-care costs. We used the Birmingham RA Model formula to convert Health Assessment Questionnaire-Disability Index values, derived from an age-adjusted comorbidity index, to utilities. We created a microsimulation model and ran 10,000 patients through sequences of three drugs to determine the incremental cost-effectiveness of beginning with adalimumab(cycling) versus abatacept(swapping).

RESULTS

The Truven cohort (n=10,442, 80% female, mean age 52yrs) were on adalimumab (n=2,732, 26.1%) and abatacept (2,073(19.9%) for a median of 418 and 582 days respectively.15.2% and 13.8% stopped biological treatment thereafter. Over two years, swapping had a higher discounted cost($66,260 vs. $65,596) and QALY(0.92 vs. 0.91) with an ICER of $74,185/QALY gained. These costs are lower than those of the full-sequence model ($74,460 and $73,838) for similar QALY benefit (ICER: $96,030/QALY). Similarly, over 5 years the swapping ICER was $99,831/QALY in the drop-out model versus $150,872/QALY in the full-sequence model.

CONCLUSIONS

To our knowledge, this is the first time patients dropping out of sequence of treatment have been modeled. While this did not affect the direction of results, there was a large impact on the ICER which has repercussions for decision makers and coverage policy. Economic evaluation guidelines should be updated to recommend including discontinuation rates for more accurate ICERs.

Conference/Value in Health Info

2020-05, ISPOR 2020, Orlando, FL, USA

Code

PBI42

Topic

Economic Evaluation, Health Service Delivery & Process of Care, Methodological & Statistical Research, Patient-Centered Research

Topic Subcategory

Adherence, Persistence, & Compliance, Modeling and simulation, Prescribing Behavior

Disease

Biologics and Biosimilars, Musculoskeletal Disorders

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