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

• Published in: Modern rheumatology 2015-07, Vol.25 (4), p.503-513
• Main Authors: Tanaka, Eiichi, Inoue, Eisuke, Hoshi, Daisuke, Shimizu, Yoko, Kobayashi, Akiko, Sugimoto, Naoki, Shidara, Kumi, Sato, Eri, Seto, Yohei, Nakajima, Ayako, Momohara, Shigeki, Taniguchi, Atsuo, Yamanaka, Hisashi
• Format: Article
• Language: English
• Subjects: Aged; Antibodies, Monoclonal, Humanized - economics; Antibodies, Monoclonal, Humanized - therapeutic use; Antirheumatic Agents - economics; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - economics; Autoimmune diseases; Cohort Studies; Cost-Benefit Analysis; Cost-effectiveness; Health Care Costs - trends; Humans; Japan; Life expectancy; Male; Markov chains; Medical treatment; Methotrexate - economics; Methotrexate - therapeutic use; Middle Aged; Monoclonal antibodies; Observational studies; Quality of Life; Quality-Adjusted Life Years; Receptors, Interleukin-6 - antagonists & inhibitors; Receptors, Interleukin-6 - immunology; Rheumatoid arthritis; Simulation; the Japanese version of the Health Assessment Questionnaire; Tocilizumab; Treatment Outcome
• ISSN: 1439-7595; 1439-7609
• DOI: 10.3109/14397595.2014.1001475

Abstract Objectives. To evaluate the cost-effectiveness of tocilizumab in patients with rheumatoid arthritis (RA) in a real-world setting in Japan. Methods. The cost-effectiveness was determined using a Markov model-based probabilistic simulation. Data from RA patients registered in the Institute of Rheumatology, Rheumatoid Arthritis (IORRA) cohort study between April 2007 and April 2011 were extracted using a pair-matching method: tocilizumab group (n = 104), patients who used at least 1 disease-modifying anti- rheumatic drug and in whom tocilizumab treatment was initiated; methotrexate group (n = 104), patients in whom methotrexate treatment was initiated for the first time or after an interruption of 6 or more months. Assuming a 6-month cycle length, health benefits and costs were measured over a lifetime and discounted at an annual rate of 3%. Results. Compared with methotrexate treatment, lifetime costs and quality-adjusted life years (QALYs) for tocilizumab treatment were approximately 1.5- and 1.3-times higher, respectively. Incremental cost per QALY gained with tocilizumab was $49,359, which was below the assumed cost-effectiveness threshold of $50,000 per QALY. The probability of tocilizumab being cost- effective was 62.2%. Conclusion. The simulation model using real-world data from Japan showed that tocilizumab (at a certain price) may improve treatment cost-effectiveness in patients with moderate-to-severe RA by enhancing quality-adjusted life expectancy.