Alemao Evo, Johal Sukhvinder, Al Maiwenn J, Rutten-van Mölken Maureen
Bristol-Myers Squibb, Princeton, NJ, USA.
PAREXEL International, London, UK.
Value Health. 2018 Feb;21(2):193-202. doi: 10.1016/j.jval.2017.05.020. Epub 2017 Jul 1.
To assess cost effectiveness of abatacept versus adalimumab, each administered with methotrexate, in treating patients with rheumatoid arthritis (RA) stratified according to baseline anticitrullinated protein antibody (ACPA) levels (marker of poor prognosis in RA).
A payer-perspective cost-effectiveness model simulated disease progression in patients with RA who had previously failed conventional disease-modifying antirheumatic drugs and were starting biologic therapy. Patients commenced treatment with abatacept or adalimumab plus methotrexate and were evaluated after 6 months. Therapy continuation was based on the European League Against Rheumatism treatment response; disease progression was based on the Health Assessment Questionnaire Disability Index score. These score changes were used to estimate health state utilities and direct medical costs. Quality-adjusted life-years (QALYs) and incremental cost per QALY gained were calculated by baseline ACPA groups (Q1, 28-234 AU/ml; Q2, 235-609 AU/ml; Q3, 613-1045 AU/ml; and Q4, 1060-4894 AU/ml). Scenario analysis and one-way and probabilistic sensitivity analyses were used to evaluate robustness of model assumptions.
Abatacept resulted in QALY gain versus adalimumab in ACPA Q1, Q3, and Q4; between-treatment difference (difference: Q1, -0.115 Q2, -0.009 Q3, 0.045; and Q4, 0.279). Total lifetime discounted cost was higher for abatacept versus adalimumab in most quartiles (Q2, £77,612 vs. £77,546; Q3, £74,441 vs. £73,263; and Q4, £78,428 vs. £76,696) because of longer time on treatment. Incremental cost per QALY for abatacept (vs. adalimumab) was the lowest in the high ACPA titer group (Q4, £6200/QALY), followed by the next lowest titer group (Q3, £26,272/QALY).
Abatacept is a cost effective alternative to adalimumab in patients with RA with high ACPA levels.
评估阿巴西普与阿达木单抗分别联合甲氨蝶呤治疗类风湿关节炎（RA）患者的成本效益，根据基线抗瓜氨酸化蛋白抗体（ACPA）水平（RA预后不良的标志物）对患者进行分层。
从支付方角度建立成本效益模型，模拟既往常规抗风湿药物治疗失败且开始生物治疗的RA患者的疾病进展。患者开始接受阿巴西普或阿达木单抗加甲氨蝶呤治疗，并在6个月后进行评估。治疗的持续基于欧洲抗风湿病联盟的治疗反应；疾病进展基于健康评估问卷残疾指数评分。这些评分变化用于估计健康状态效用和直接医疗成本。通过基线ACPA组（Q1，28 - 234 AU/ml；Q2，235 - 609 AU/ml；Q3，613 - 1045 AU/ml；Q4，1060 - 4894 AU/ml）计算质量调整生命年（QALY）和每获得一个QALY的增量成本。采用情景分析、单因素和概率敏感性分析来评估模型假设的稳健性。
在ACPA Q1、Q3和Q4组中，阿巴西普相对于阿达木单抗导致QALY增加；治疗组间差异（差异：Q1， - 0.115；Q2， - 0.009；Q3，0.045；Q4，0.279）。在大多数四分位数中，阿巴西普的终身总贴现成本高于阿达木单抗（Q2，77,612英镑对77,546英镑；Q3，74,441英镑对73,263英镑；Q4，78,428英镑对76,696英镑），因为治疗时间更长。阿巴西普（相对于阿达木单抗）每QALY的增量成本在高ACPA滴度组（Q4，6200英镑/QALY）中最低，其次是次低滴度组（Q3，26,272英镑/QALY）。
对于ACPA水平高的RA患者，阿巴西普是阿达木单抗的一种具有成本效益的替代药物。
