OBJECTIVES : To determine the cost-effectiveness of sarilumab (KEVZARA), a new treatment targeted against alpha subunit of interleukin-6 receptor complex (IL-6R), versus adalimumab (HUMIRA), a biologic DMARDs, for patients with high disease activity of rheumatoid arthritis (RA).

METHODS : A 5-year Markov state transition period with 6 month cycles was used to assess four possible health states patients being treated with sarilumab or adalimumab would progress to. The four health states were determined based off of DAS28-ESR scores to measure RA disease activity: > 3.2, High Disease Activity (HDA); ≤ 3.2 and > 2.6, Low Disease Activity (LDA); < 2.6, Remission; and Dead. Drug costs were calculated from average wholesale price from online available drug markets and were expressed in 2017 US dollar. Additional direct medical costs and utility measurements were collected from literature. The outcome was the incremental cost-effectiveness ratio (ICER) expressed as cost per quality adjusted life year (QALY). Best case scenario sensitivity analysis was conducted to explore the impact of different scenarios.

RESULTS : The cumulative cost and effectiveness at the end of the cycle for sarilumab and adalimumab was $205,869.12; 6.18, and $298,880.66; 5.59, respectively. In the cost-effectiveness analysis, adalimumab was dominated, whereas, sarilumab was not dominated. Results of the best-case scenario sensitivity analysis also verified that sarilumab was more cost-effective than adalimumab.

CONCLUSIONS : The results of the study have an important implication that the new treatment sarilumab (KEVZARA) may be more cost-effective when compared to adalimumab (HUMIRA) for treating patients with rheumatoid arthritis.