Ferrufino Cheryl P, Munakata Julie, Wei Wenhui, Proudfoot Clare, Kuznik Andreas, Boklage Susan H, Chen Chieh-I
IQVIA, Fairfax, VA, USA.
Sanofi, Bridgewater, NJ, USA.
Clinicoecon Outcomes Res. 2018 Nov 16;10:805-819. doi: 10.2147/CEOR.S163829. eCollection 2018.
To estimate the 5-year budget impact (BI) on a US health plan of introducing sarilumab - a human immunoglobulin G1 anti-IL-6 receptor α monoclonal antibody - as combination treatment with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) or monotherapy in patients with moderate-to-severe rheumatoid arthritis (RA).
BI analysis was conducted from a commercial payer perspective. Treatment-eligible populations included adult patients with moderate-to-severe RA and inadequate response (IR) to csDMARDs or tumor necrosis factor (TNF)-α inhibitors-IR. All licensed biologic treatments recommended by the American College of Rheumatology guidelines were included.
For a hypothetical plan of one million members, 409 csDMARD-IR and 345 TNF-IR patients were annually eligible for combination therapy and 226 csDMARD and TNF-IR patients for monotherapy with sarilumab. Based on 2018 US direct treatment costs, the introduction of sarilumab was estimated to save $526,424, $322,637 and $264,306 over 5 years for csDMARD-IR combination therapy patients, TNF-IR combination therapy patients, and csDMARD-IR/TNF-IR monotherapy patients, respectively. As sarilumab absorbed a greater market share over the horizon, annual savings increased from years 1 to 5, $28,610 (-0.14%) to $194,646 (-0.83%) in csDMARD-IR, $16,986 (-0.11%) to $120,893 (-0.67%) in TNF-IR, and $14,256 (-0.13%) to $98,040 (-0.79%) in monotherapy. One-way sensitivity analyses revealed that the model was most sensitive to variations in sarilumab adherence.
Total cost savings of introducing sarilumab to a health-care plan accrued from years 1 to 5, attributable to the lower treatment cost, stable dosing paradigm, and price parity for the two available doses (150 and 200 mg every 2 weeks) compared with alternative biologic DMARDs that have substantial variability in dose titration/schedules.
评估将沙瑞鲁单抗（一种人免疫球蛋白G1抗白细胞介素-6受体α单克隆抗体）作为中度至重度类风湿性关节炎（RA）患者的联合治疗药物与传统合成改善病情抗风湿药（csDMARDs）联合使用或单药治疗，对美国一项健康计划产生的5年预算影响（BI）。
从商业付款人的角度进行预算影响分析。符合治疗条件的人群包括患有中度至重度RA且对csDMARDs或肿瘤坏死因子（TNF）-α抑制剂反应不足（IR）的成年患者。美国风湿病学会指南推荐的所有已获许可的生物治疗均包括在内。
对于一个拥有100万会员的假设计划，每年有409名对csDMARDs反应不足（IR）的患者和345名对TNF反应不足（IR）的患者有资格接受联合治疗，226名对csDMARDs和TNF反应不足（IR）的患者有资格接受沙瑞鲁单抗单药治疗。根据2018年美国直接治疗成本估算，对于对csDMARDs反应不足（IR）的联合治疗患者、对TNF反应不足（IR）的联合治疗患者以及对csDMARDs/TNF反应不足（IR）的单药治疗患者，在5年内引入沙瑞鲁单抗预计分别节省526,424美元、322,637美元和264,306美元。随着沙瑞鲁单抗在未来占据更大的市场份额，从第1年到第5年年度节省费用增加，对csDMARDs反应不足（IR）的患者从28,610美元（-0.14%）增至194,646美元（-0.83%），对TNF反应不足（IR）的患者从16,986美元（-0.11%）增至120,893美元（-0.67%），单药治疗患者从14,256美元（-0.13%）增至98,040美元（-0.79%）。单向敏感性分析显示，该模型对沙瑞鲁单抗依从性的变化最为敏感。
将沙瑞鲁单抗引入医疗保健计划可在1至5年内实现总成本节省，这归因于其较低的治疗成本、稳定的给药模式以及两种可用剂量（每2周150和200毫克）的价格平价，而与之相比，其他生物性DMARDs在剂量滴定/给药方案方面存在很大差异。
