European Analysis Finds Infliximab to Be Most Cost-Effective Biologic for RA

While the treatment of rheumatoid arthritis (RA) has been revolutionized by the use of biologics and biosimilars, access to these drugs is unequal among patients in higher- and lower-resource nations. In Poland, for example, only approximately 1% of patients with RA are able to access a biologic therapy.

According to a paper newly published in Reumatologica, a cost-effectiveness analysis of biologics available to treat RA can help guide decision making for countries like Poland that hope to maximize patient benefit while making judicious use of limited resources.

The paper reports findings from a study that used retrospective data from a single center in Poland from 2009 to 2014. Records from a total of 104 patients, each of whom received infliximab, etanercept, or adalimumab under the National Health Fund, were assessed. The time horizon of patient documentation spanned the time from treatment initiation to remission.

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The average improvement in disease activity score in a count of 28 joints was 3.30 for the infliximab group, 3.51 for the etanercept group, and 3.70 for the adalimumab group. Patients receiving all 3 therapies had a decrease in disease activity as measured by the visual analogue scale, and clinical remission was achieved by 85.29% of patients receiving adalimumab, 74.07% of those receiving etanercept, and 37.21% of those receiving infliximab.

While fewer infliximab-treated patients achieved remission, the infliximab group showed the greatest change from baseline on the health assessment questionnaire—disability index, with a drop from 1.21 to 0.76 (vs 1.59 to 1.38 for etanercept-treated patients and 1.71 to 1.53 for adalimumab-treated patients). Furthermore, after a 2-year followup period, the best quality-adjusted life-year (QALY) results were for the infliximab group; infliximab was associated with a 1.71 QALY gain, while etanercept and adalimumab were associated with QALY gains of 0.74 and 0.60, respectively.

Infliximab was also associated with the lowest average medical cost per patient, followed by etanercept. Adalimumab was associated with the highest average medical cost.

The authors of the analysis write that their findings make it easier for clinicians to decide on the most appropriate treatment for patients with RA and can help to strike the all-important balance between effective treatment and the financial sustainability of the healthcare system.

Reference

Kowalik K, Węgierska M, Barczyńska T, Jeka S. Pharmacoeconomic evaluation of treatment effectiveness with selected biologic treatment in rheumatoid arthritis therapy. Reumatologica. 2018;56(4):212-218. doi: 10.5114/reum.2018.77972.