Objective: Rituximab (RTX) is licensed for second line treatment of rheumatoid arthritis (RA) after first TNF inhibitor failure. RTX is generally administered intravenously 1 g x 2 (day 1- day 15) and the retreatment is scheduled at the time of clinical relapse (Regimen 1). A more intensive regimen is proposed with a fixed full cycle after six months (Regimen 2) if remission is not reached. A cost-effectiveness analysis (CEA) compares these two regimens of RTX administration in longstanding RA patients based on data provided by an observational study. Methods: An observational retrospective study was conducted on 102 patients, enrolled in three hospitals and followed for ≥12 months. Forty-seven patients followed Regimen 1, while fifty-five followed Regimen 2. A CEA based on a Markov Model, was conducted. A lifelong and social perspective was adopted. CEA was conducted for the whole cohort and for two subgroups separately (patients with positive rheumatoid factor and/or anti-cyclic citrullinated peptide and failures to TNF inhibitors). Results: Results for the overall sample show at 10-20-30 year that Regimen 1 is less costly and associated with a higher QoL compared to Regimen 2. PSA at 10 years estimated a probability of 95.1% for Regimen 1 to be cost-effective given a willingness-to pay of 35,000 € /QALY, while for seropositive patients and for TNF failures it was estimated to be 92%, and 92.7% respectively. Conclusion: In longstanding RA, cost-effectiveness of RTX retreatment at clinical relapse was found to be at least equivalent to the more intensive regimen proposed.
Cost-effectiveness analysis of two Rituximab retreatment regimens for longstanding rheumatoid arthritis
BIASI, Domenico;ADAMI, Silvano;
2015-01-01
Abstract
Objective: Rituximab (RTX) is licensed for second line treatment of rheumatoid arthritis (RA) after first TNF inhibitor failure. RTX is generally administered intravenously 1 g x 2 (day 1- day 15) and the retreatment is scheduled at the time of clinical relapse (Regimen 1). A more intensive regimen is proposed with a fixed full cycle after six months (Regimen 2) if remission is not reached. A cost-effectiveness analysis (CEA) compares these two regimens of RTX administration in longstanding RA patients based on data provided by an observational study. Methods: An observational retrospective study was conducted on 102 patients, enrolled in three hospitals and followed for ≥12 months. Forty-seven patients followed Regimen 1, while fifty-five followed Regimen 2. A CEA based on a Markov Model, was conducted. A lifelong and social perspective was adopted. CEA was conducted for the whole cohort and for two subgroups separately (patients with positive rheumatoid factor and/or anti-cyclic citrullinated peptide and failures to TNF inhibitors). Results: Results for the overall sample show at 10-20-30 year that Regimen 1 is less costly and associated with a higher QoL compared to Regimen 2. PSA at 10 years estimated a probability of 95.1% for Regimen 1 to be cost-effective given a willingness-to pay of 35,000 € /QALY, while for seropositive patients and for TNF failures it was estimated to be 92%, and 92.7% respectively. Conclusion: In longstanding RA, cost-effectiveness of RTX retreatment at clinical relapse was found to be at least equivalent to the more intensive regimen proposed.
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