TY - JOUR
T1 - Economic Evaluation of Sarilumab in the Treatment of Adult Patients with Moderately-to-Severely Active Rheumatoid Arthritis Who Have an Inadequate Response to Conventional Synthetic Disease-Modifying Antirheumatic Drugs
AU - Muszbek, Noemi
AU - Proudfoot, Clare
AU - Fournier, Marie
AU - Chen, Chieh I.
AU - Kuznik, Andreas
AU - Kiss, Zsofia
AU - Gal, Peter
AU - Michaud, Kaleb
N1 - Funding Information:
Funding. This study, the article processing charges and open access fee were funded by Sanofi and Regeneron Pharmaceuticals, Inc. The sponsor was involved in the study design, collection, analysis and interpretation of data as well as data checking of information provided in the manuscript. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.
Funding Information:
Medical Writing and Editorial Assis tance. Medical writing assistance and editorial support, under the direction of the authors, were respectively provided by Gauri Saal, MA Economics and Sinead Stewart of Prime (Knutsford, UK), funded by the Sponsor, Sanofi and Regeneron Pharmaceuticals, Inc., according to Good Publication Practice guidelines (http:// annals.org/aim/article/2424869).
Funding Information:
Disclosures. Noemi Muszbek is an employee of a company which has received consulting fees from Sanofi/Regeneron. Zsofia Kiss is an employee of a company which has received consulting fees from Sanofi/Regeneron. Peter Gal is an employee of a company which has received consulting fees from Sanofi/Regeneron. Andreas Kuznik is a current employee of and stockholder in Regeneron Pharmaceuticals, Inc. C-I Chen is a current employee of and stockholder in Regeneron Pharmaceuticals, Inc. Marie Fournier is an employee of and stockholder in Sanofi. Clare Proudfoot is a former employee of and current stockholder in Sanofi and current employee and stockholder in Novartis. Kaleb Michaud has received grant funding from Pfizer and the Rheumatology Research Foundation.
Funding Information:
The authors would like to thank Thi-Minh-Thao Huynh for input into the design and analysis of the network meta-analysis comparing licensed DMARDs for the treatment of RA, Susan Boklage for input to the CEA study design and Yuxin Li for assistance in programming the CEA analytical model and data collection. This study, the article processing charges and open access fee were funded by Sanofi and Regeneron Pharmaceuticals, Inc. The sponsor was involved in the study design, collection, analysis and interpretation of data as well as data checking of information provided in the manuscript. All authors had full access to all of the data in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis. Medical writing assistance and editorial support, under the direction of the authors, were respectively provided by Gauri Saal, MA Economics and Sinead Stewart of Prime (Knutsford, UK), funded by the Sponsor, Sanofi and Regeneron Pharmaceuticals, Inc., according to Good Publication Practice guidelines (http://annals.org/aim/article/2424869). All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole and have given their approval for this version to be published. Noemi Muszbek is an employee of a company which has received consulting fees from Sanofi/Regeneron. Zsofia Kiss is an employee of a company which has received consulting fees from Sanofi/Regeneron. Peter Gal is an employee of a company which has received consulting fees from Sanofi/Regeneron. Andreas Kuznik is a current employee of and stockholder in Regeneron Pharmaceuticals, Inc. C-I Chen is a current employee of and stockholder in Regeneron Pharmaceuticals, Inc. Marie Fournier is an employee of and stockholder in Sanofi. Clare Proudfoot is a former employee of and current stockholder in Sanofi and current employee and stockholder in Novartis. Kaleb Michaud has received grant funding from Pfizer and the Rheumatology Research Foundation. This article does not contain any studies with human participants or animals performed by any of the authors. The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
Publisher Copyright:
© 2019, The Author(s).
PY - 2019/6/1
Y1 - 2019/6/1
N2 - Introduction: Assess the cost-effectiveness (US healthcare payer perspective) of sarilumab subcutaneous (SC) 200 mg + methotrexate versus conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) or targeted DMARD + methotrexate for moderate-to-severe rheumatoid arthritis (RA) in adults with inadequate response to methotrexate. Methods: Microsimulation based on patient profiles from MOBILITY (NCT01061736) was conducted via a 6-month decision tree and lifetime Markov model with 6-monthly cycles. Treatment response at 6 months was informed by a network meta-analysis and based on American College of Rheumatology (ACR) response. Responders: patients with ACR20 response who continued with therapy; non-responders: ACR20 non-responders who transitioned to the subsequent treatment. Utilities and quality-adjusted life-years (QALYs) were estimated via mapping 6-month ACR20/50/70 response to relative change in Health Assessment Questionnaire Disability Index score (short term) and based on published algorithms (long term). Direct costs considered drugs (wholesale acquisition costs), administration and routine care. Results: Lifetime QALYs and costs for treatment sequences on the efficiency frontier were 3.43 and $115,019 for active csDMARD, 5.79 and $430,918 for sarilumab, and 5.94 and $524,832 for etanercept (all others dominated). Sarilumab was cost-effective versus tocilizumab and csDMARD (incremental cost-effectiveness ratios of $84,079/QALY and $134,286/QALY). Probabilistic sensitivity analysis suggested comparable costs and slightly improved health benefits for sarilumab versus tocilizumab, irrespective of threshold. Conclusion: In patients with moderate-to-severe RA, sarilumab 200 mg SC every 2 weeks + methotrexate can be considered a cost-effective treatment option, with lower costs and greater health benefits than alternative treatment sequences (+ methotrexate) beginning with adalimumab, certolizumab, golimumab and tofacitinib and below commonly accepted cost-effectiveness thresholds against tocilizumab + methotrexate or csDMARD active treatment. Funding: Sanofi and Regeneron Pharmaceuticals, Inc.
AB - Introduction: Assess the cost-effectiveness (US healthcare payer perspective) of sarilumab subcutaneous (SC) 200 mg + methotrexate versus conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs) or targeted DMARD + methotrexate for moderate-to-severe rheumatoid arthritis (RA) in adults with inadequate response to methotrexate. Methods: Microsimulation based on patient profiles from MOBILITY (NCT01061736) was conducted via a 6-month decision tree and lifetime Markov model with 6-monthly cycles. Treatment response at 6 months was informed by a network meta-analysis and based on American College of Rheumatology (ACR) response. Responders: patients with ACR20 response who continued with therapy; non-responders: ACR20 non-responders who transitioned to the subsequent treatment. Utilities and quality-adjusted life-years (QALYs) were estimated via mapping 6-month ACR20/50/70 response to relative change in Health Assessment Questionnaire Disability Index score (short term) and based on published algorithms (long term). Direct costs considered drugs (wholesale acquisition costs), administration and routine care. Results: Lifetime QALYs and costs for treatment sequences on the efficiency frontier were 3.43 and $115,019 for active csDMARD, 5.79 and $430,918 for sarilumab, and 5.94 and $524,832 for etanercept (all others dominated). Sarilumab was cost-effective versus tocilizumab and csDMARD (incremental cost-effectiveness ratios of $84,079/QALY and $134,286/QALY). Probabilistic sensitivity analysis suggested comparable costs and slightly improved health benefits for sarilumab versus tocilizumab, irrespective of threshold. Conclusion: In patients with moderate-to-severe RA, sarilumab 200 mg SC every 2 weeks + methotrexate can be considered a cost-effective treatment option, with lower costs and greater health benefits than alternative treatment sequences (+ methotrexate) beginning with adalimumab, certolizumab, golimumab and tofacitinib and below commonly accepted cost-effectiveness thresholds against tocilizumab + methotrexate or csDMARD active treatment. Funding: Sanofi and Regeneron Pharmaceuticals, Inc.
KW - Cost effectiveness
KW - Disease-modifying anti-rheumatic
KW - IL-6
KW - Rheumatoid arthritis
KW - Sarilumab
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U2 - 10.1007/s12325-019-00946-1
DO - 10.1007/s12325-019-00946-1
M3 - Article
C2 - 31004324
AN - SCOPUS:85064636384
SN - 0741-238X
VL - 36
SP - 1337
EP - 1357
JO - Advances in Therapy
JF - Advances in Therapy
IS - 6
ER -