OBJECTIVES: To investigate the cost-effectiveness of abatacept (ABA) as first-line (1L) therapy in Japanese rheumatoid arthritis (RA) patients using data from the Institute of Rheumatology, Rheumatoid Arthritis database.
METHODS: A decision-analytic model was used to estimate the cost per American College of Rheumatology response of at least 50% improvement (ACR50) responder and per patient in Clinical Disease Activity Index (CDAI) and Simplified Disease Activity Index (SDAI) remission from a Japanese healthcare payers' perspective over a 2-year time horizon. Clinical characteristics of patients on ABA-1L were matched with those of patients on ABA second or later line (2L+) or tumour necrosis factor inhibitor (TNFi)-1L directly or using propensity scores. Resource utilisation and medical costs were calculated from the Japan Medical Data Center claims database. Parameter uncertainty was addressed by sensitivity and subgroup analyses (age, treatment duration, Japanese version of Health Assessment Questionnaire [J-HAQ] score).
RESULTS: Incremental costs per member per month (DeltaPMPM) for ABA-1L versus TNFi-1L and ABA-2L+ were -1,571 Japanese Yen (JPY) and 81 JPY, respectively. For ABA-1L versus TNFi-1L, DeltaPMPM by ACR50 response was -11,715 JPY and by CDAI and SDAI remission 11,602 JPY and 47,003 JPY, respectively. Corresponding costs for ABA-1L were lower for all outcome parameters versus those for ABA-2L+. Scenario analyses showed that ABA-1L was cost-effective over TNFi-1L in patients <65 years for any outcome. Furthermore, ABA-1L was cost-effective over ABA-2L+ for all outcomes in patients with age <65 years, disease duration <5 years and J-HAQ >/=1.5.
CONCLUSIONS: ABA-1L demonstrated a favourable cost-effectiveness profile in RA patients, accruing savings for the Japanese healthcare payers.
|投稿者||Tanaka, Eiichi; Inoue, Eisuke; Shoji, Ayako; Nilsson, Jonas; Papagiannopoulos, Christos; Dhanda, Devender; Yoshizawa, Yuri; Abe, Mai; Saka, Kumiko; Sugano, Eri; Sugitani, Naohiro; Ochiai, Moeko; Yamaguchi, Rei; Ikari, Katsunori; Yamanaka, Hisashi; Harigai, Masayoshi|
|組織名||Division of Rheumatology, Department of Internal Medicine, Tokyo Women's Medical;University School of Medicine, Tokyo, Japan.;Department of Rheumatology, Institute of Rheumatology, Tokyo Women's Medical;University Hospital, Tokyo, Japan.;Research Administration Center, Showa University, Tokyo, Japan.;Medilead Inc., Tokyo, Japan.;ICON plc., Stockholm, Sweden.;Bristol-Myers Squibb, Lawrenceville, New Jersey, United States of America.;Bristol-Myers Squibb, Tokyo, Japan.;Department of Orthopedics, Institute of Rheumatology, Tokyo Women's Medical;Rheumatology, Sanno Medical Center, Tokyo, Japan.;Department of Rheumatology, International University of Health and Welfare,;Tokyo, Japan.|