Cost minimization analysis of intravenous treatment for rheumatoid arthritis

Objective: To compare the cost of treating Rheumatoid Arthritis (RA) patients that have failed an initial treatment with methotrexate􀀏 with intravenous infliximab􀀏 tocilizumab and abatacept. Method: Infliximab,􀀏 tocilizumab and abatacept are considered with similar effectiveness. A cost-minimization analysis was therefore considered appropriate. The Hospital perspective and a three year time horizon were selected. Pharmaceutical and administration costs (€, 2013) were considered. Deterministic sensitivity analyses were performed. Results: Our results showing that during the first year of treatment, abatacept is the less costly therapy for those patients weighing 86 to 100 kg. Costs for treatments using infliximab or tocilizumab are virtually equivalent (although slightly better for infliximab) up to administration to patients weighing more than 100 kg, in which case the most economical therapy is tocilizumab. After three years of treatment, analysis of average yearly spending shows that treatment using infliximab is the most economical for most of the patients, except for those with highest weights (>125 kg). Conclusions: This study is not intended for substituting the clinical treatment guidelines, but its main target is to show a simulation model offering useful additional information for decision taking. In it, a novel aspect is shown, the prescription of these treatments depending on the patients’ weight, allowing a resource optimization which achieves important savings. In particular, applying this model on a RA patients population of a third-tier hospital treated with infliximab, abatacept and tocilizumab would imply €78,235/year savings