Inadequate efficacy or intolerance with conventional synthetic disease-modifying antirheumatic drug in rheumatoid arthritis patients: a systematic review of pharmacoeconomic evaluation_Chinese Journal of Evidence-Based Medicine

Authors：

XIONG Xiaomo , WANG Luying ,  TIAN Lei

School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, 211198, P.R.China;

Corresponding?author：

TIAN Lei, Email: cputianlei@163.com

Keywords：

Rheumatoid arthritis; TNFi; tsDMARDs; Pharmacoeconomics; Systematic review

DOI：

10.7507/1672-2531.201903037

Video：

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Objectives To review the pharmacoeconomic evaluation of rheumatoid arthritis patients with an inadequate efficacy or intolerance with conventional synthetic disease modifying antirheumatic drugs (csDMARDs).Methods CNKI, WanFang Data, VIP, PubMed, EMbase, Web of Science and The Cochrane Library were electronically searched to collect pharmacoeconomic studies about rheumatoid arthritis patients with an inadequate efficacy or intolerance with csDMARDs from inception to February 2019. Two reviewers independently screened literature, extracted data and assessed risk of bias of the included studies, then, descriptive analysis was performed.Results A total of 16 studies were included, where most compared the economics of different treatment methods from the perspective of the payer by cohort or individual model. The economic costs in the studies were primarily on direct cost. Sensitivity analyses were used to prove the robustness of the main analysis in each study. Biological disease-modifying antirheumatic drugs (bDMARDs) might be more cost-effective than csDMARDs. In addition, compared with the bDMARDs, new-marketed targeted synthetic disease-modifying antirheumatic drugs (tsDMARDs) might be more cost-effective.Conclusions It could be considered to implement more new marketed tsDMARDs to improve patients’ condition to reduce the economic burden and optimize the allocation of health care resources.

Citation： XIONG Xiaomo, WANG Luying, TIAN Lei. Inadequate efficacy or intolerance with conventional synthetic disease-modifying antirheumatic drug in rheumatoid arthritis patients: a systematic review of pharmacoeconomic evaluation. Chinese Journal of Evidence-Based Medicine, 2019, 19(11): 1300-1307. doi: 10.7507/1672-2531.201903037 Copy

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2.	Firestein GS. Evolving concepts of rheumatoid arthritis. Nature, 2003, 423(6937): 356-361.
3.	中華醫學會風濕病學分會. 2018中國類風濕關節炎診療指南. 中華內科雜志, 2018, 57(4): 242-251.
4.	Smolen JS, Steiner G. Therapeutic strategies for rheumatoid arthritis. Nat Rev Drug Discov, 2003, 2(6): 473-488.
5.	Hu H, Luan L, Yang K, et al. Burden of rheumatoid arthritis from a societal perspective: a prevalence-based study on cost of this illness for patients in China. Int J Rheum Dis, 2018, 21(8): 1572-1580.
6.	史方, 傅華, 盧偉, 等. 上海市關節炎疾病負擔評價. 上海: 復旦大學, 2005.
7.	Steinbrocker O, Traeger CH, Batterman RC. Therapeutic criteria in rheumatoid arthritis. J Am Med Assoc, 1949, 140(8): 659-662.
8.	曾小峰, 朱松林, 譚愛春, 等. 我國類風濕關節炎疾病負擔和生存質量研究的系統評價. 中國循證醫學雜志, 2013, 13(3): 300-307.
9.	Ofman JJ, Sullivan SD, Neumann PJ, et al. Examining the value and quality of health economic analyses: implications of utilizing the QHES. J Manag Care Pharm, 2003, 9(1): 53-61.
10.	Brennan A, Bansback N, Reynolds A, et al. Modelling the cost-effectiveness of etanercept in adults with rheumatoid arthritis in the UK. Rheumatology (Oxford), 2004, 43(1): 62-72.
11.	Soini EJ, Hallinen TA, Puolakka K, et al. Cost-effectiveness of adalimumab, etanercept, and tocilizumab as first-line treatments for moderate-to-severe rheumatoid arthritis. J Med Econ, 2012, 15(2): 340-351.
12.	Diamantopoulos A, Benucci M, Capri S, et al. Economic evaluation of tocilizumab combination in the treatment of moderate-to-severe rheumatoid arthritis in Italy. J Med Econ, 2012, 15(3): 576-585.
13.	Diamantopoulos A, Finckh A, Huizinga T, et al. Tocilizumab in the treatment of rheumatoid arthritis: a cost-effectiveness analysis in the UK. Pharmacoeconomics, 2014, 32(8): 775-787.
14.	Athanasakis K, Tarantilis F, Tsalapati K, et al. Cost-utility analysis of tocilizumab monotherapy in first line versus standard of care for the treatment of rheumatoid arthritis in Greece. Rheumatol Int, 2015, 35(9): 1489-1495.
15.	Carlson JJ, Ogale S, Dejonckheere F, et al. Economic evaluation of tocilizumab monotherapy compared to adalimumab monotherapy in the treatment of severe active rheumatoid arthritis. Value Health, 2015, 18(2): 173-179.
16.	Hidalgo-Vega á, Villoro R, Blasco JA, et al. Cost-utility analysis of certolizumab pegol versus alternative tumour necrosis factor inhibitors available for the treatment of moderate-to-severe active rheumatoid arthritis in Spain. Cost Eff Resour Alloc, 2015, 13: 11.
17.	Lee MY, Park SK, Park SY, et al. Cost-effectiveness of tofacitinib in the treatment of moderate to severe rheumatoid arthritis in South Korea. Clin Ther, 2015, 37(8): 1662-1676.
18.	Tanaka E, Inoue E, Hoshi D, et al. Cost-effectiveness of tocilizumab, a humanized anti-interleukin-6 receptor monoclonal antibody, versus methotrexate in patients with rheumatoid arthritis using real-world data from the IORRA observational cohort study. Mod Rheumatol, 2015, 25(4): 503-513.
19.	Hashemi-Meshkini A, Nikfar S, Glaser E, et al. Cost-effectiveness analysis of tocilizumab in comparison with infliximab in iranian rheumatoid arthritis patients with inadequate response to tDMARDs: a multistage markov model. Value Health Reg Issues, 2016, 9: 42-48.
20.	Park SK, Park SH, Lee MY, et al. Cost-effectiveness analysis of treatment sequence initiating with etanercept compared with leflunomide in rheumatoid arthritis: impact of reduced etanercept cost with patent expiration in South Korea. Clin Ther, 2016, 38(11): 2430-2446.
21.	Jansen JP, Incerti D, Mutebi A, et al. Cost-effectiveness of sequenced treatment of rheumatoid arthritis with targeted immune modulators. J Med Econ, 2017, 20(7): 703-714.
22.	Tzanetakos C, Tzioufas A, Goules A, et al. Cost-utility analysis of certolizumab pegol in combination with methotrexate in patients with moderate-to-severe active rheumatoid arthritis in Greece. Rheumatol Int, 2017, 37(9): 1441-1452.
23.	Alemao E, Johal S, Al MJ, et al. Cost-Effectiveness analysis of abatacept compared with adalimumab on background methotrexate in biologic-naive adult patients with rheumatoid arthritis and poor prognosis. Value Health, 2018, 21(2): 193-202.
24.	Claxton L, Taylor M, Gerber RA, et al. Modelling the cost-effectiveness of tofacitinib for the treatment of rheumatoid arthritis in the United States. Curr Med Res Opin, 2018, 34(11): 1991-2000.
25.	Whittington MD, McQueen RB, Ollendorf DA, et al. Assessing the value of sarilumab monotherapy for adults with moderately to severely active rheumatoid arthritis: a cost-effectiveness analysis. J Manag Care Spec Pharm, 2019, 25(1): 80-87.
26.	Launois R, Avouac B, Berenbaum F, et al. Comparison of certolizumab pegol with other anticytokine agents for treatment of rheumatoid arthritis: a multiple-treatment Bayesian metaanalysis. J Rheumatol, 2011, 38(5): 835-845.

1. McInnes IB, Schett G. The pathogenesis of rheumatoid arthritis. N Engl J Med, 2011, 365(23): 2205-2219.
2. Firestein GS. Evolving concepts of rheumatoid arthritis. Nature, 2003, 423(6937): 356-361.
3. 中華醫學會風濕病學分會. 2018中國類風濕關節炎診療指南. 中華內科雜志, 2018, 57(4): 242-251.
4. Smolen JS, Steiner G. Therapeutic strategies for rheumatoid arthritis. Nat Rev Drug Discov, 2003, 2(6): 473-488.
5. Hu H, Luan L, Yang K, et al. Burden of rheumatoid arthritis from a societal perspective: a prevalence-based study on cost of this illness for patients in China. Int J Rheum Dis, 2018, 21(8): 1572-1580.
6. 史方, 傅華, 盧偉, 等. 上海市關節炎疾病負擔評價. 上海: 復旦大學, 2005.
7. Steinbrocker O, Traeger CH, Batterman RC. Therapeutic criteria in rheumatoid arthritis. J Am Med Assoc, 1949, 140(8): 659-662.
8. 曾小峰, 朱松林, 譚愛春, 等. 我國類風濕關節炎疾病負擔和生存質量研究的系統評價. 中國循證醫學雜志, 2013, 13(3): 300-307.
9. Ofman JJ, Sullivan SD, Neumann PJ, et al. Examining the value and quality of health economic analyses: implications of utilizing the QHES. J Manag Care Pharm, 2003, 9(1): 53-61.
10. Brennan A, Bansback N, Reynolds A, et al. Modelling the cost-effectiveness of etanercept in adults with rheumatoid arthritis in the UK. Rheumatology (Oxford), 2004, 43(1): 62-72.
11. Soini EJ, Hallinen TA, Puolakka K, et al. Cost-effectiveness of adalimumab, etanercept, and tocilizumab as first-line treatments for moderate-to-severe rheumatoid arthritis. J Med Econ, 2012, 15(2): 340-351.
12. Diamantopoulos A, Benucci M, Capri S, et al. Economic evaluation of tocilizumab combination in the treatment of moderate-to-severe rheumatoid arthritis in Italy. J Med Econ, 2012, 15(3): 576-585.
13. Diamantopoulos A, Finckh A, Huizinga T, et al. Tocilizumab in the treatment of rheumatoid arthritis: a cost-effectiveness analysis in the UK. Pharmacoeconomics, 2014, 32(8): 775-787.
14. Athanasakis K, Tarantilis F, Tsalapati K, et al. Cost-utility analysis of tocilizumab monotherapy in first line versus standard of care for the treatment of rheumatoid arthritis in Greece. Rheumatol Int, 2015, 35(9): 1489-1495.
15. Carlson JJ, Ogale S, Dejonckheere F, et al. Economic evaluation of tocilizumab monotherapy compared to adalimumab monotherapy in the treatment of severe active rheumatoid arthritis. Value Health, 2015, 18(2): 173-179.
16. Hidalgo-Vega á, Villoro R, Blasco JA, et al. Cost-utility analysis of certolizumab pegol versus alternative tumour necrosis factor inhibitors available for the treatment of moderate-to-severe active rheumatoid arthritis in Spain. Cost Eff Resour Alloc, 2015, 13: 11.
17. Lee MY, Park SK, Park SY, et al. Cost-effectiveness of tofacitinib in the treatment of moderate to severe rheumatoid arthritis in South Korea. Clin Ther, 2015, 37(8): 1662-1676.
18. Tanaka E, Inoue E, Hoshi D, et al. Cost-effectiveness of tocilizumab, a humanized anti-interleukin-6 receptor monoclonal antibody, versus methotrexate in patients with rheumatoid arthritis using real-world data from the IORRA observational cohort study. Mod Rheumatol, 2015, 25(4): 503-513.
19. Hashemi-Meshkini A, Nikfar S, Glaser E, et al. Cost-effectiveness analysis of tocilizumab in comparison with infliximab in iranian rheumatoid arthritis patients with inadequate response to tDMARDs: a multistage markov model. Value Health Reg Issues, 2016, 9: 42-48.
20. Park SK, Park SH, Lee MY, et al. Cost-effectiveness analysis of treatment sequence initiating with etanercept compared with leflunomide in rheumatoid arthritis: impact of reduced etanercept cost with patent expiration in South Korea. Clin Ther, 2016, 38(11): 2430-2446.
21. Jansen JP, Incerti D, Mutebi A, et al. Cost-effectiveness of sequenced treatment of rheumatoid arthritis with targeted immune modulators. J Med Econ, 2017, 20(7): 703-714.
22. Tzanetakos C, Tzioufas A, Goules A, et al. Cost-utility analysis of certolizumab pegol in combination with methotrexate in patients with moderate-to-severe active rheumatoid arthritis in Greece. Rheumatol Int, 2017, 37(9): 1441-1452.
23. Alemao E, Johal S, Al MJ, et al. Cost-Effectiveness analysis of abatacept compared with adalimumab on background methotrexate in biologic-naive adult patients with rheumatoid arthritis and poor prognosis. Value Health, 2018, 21(2): 193-202.
24. Claxton L, Taylor M, Gerber RA, et al. Modelling the cost-effectiveness of tofacitinib for the treatment of rheumatoid arthritis in the United States. Curr Med Res Opin, 2018, 34(11): 1991-2000.
25. Whittington MD, McQueen RB, Ollendorf DA, et al. Assessing the value of sarilumab monotherapy for adults with moderately to severely active rheumatoid arthritis: a cost-effectiveness analysis. J Manag Care Spec Pharm, 2019, 25(1): 80-87.
26. Launois R, Avouac B, Berenbaum F, et al. Comparison of certolizumab pegol with other anticytokine agents for treatment of rheumatoid arthritis: a multiple-treatment Bayesian metaanalysis. J Rheumatol, 2011, 38(5): 835-845.

Chinese Journal of Evidence-Based Medicine

Inadequate efficacy or intolerance with conventional synthetic disease-modifying antirheumatic drug in rheumatoid arthritis patients: a systematic review of pharmacoeconomic evaluation

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