Abstract: Introduction
Rheumatoid arthritis (RA) is a chronic inflammatory disease
which affects joints and can lead to deformity of
proximal organs due to erosion [1]. Prevalence of RA
is ranging from 0.3 to 2.1 % in different societies [2]. As
reported before, 0.33 % of urban population and 0.19 % of
rural population are affected with RA in Iran [3]. With over
77 million population [4], it can be estimated that about
42,000 people in rural area and over 181,000 in urban area
are suffering from RA in this country, which includes about
20–40 thousands of disabled individuals.
Although still no exact cause has been identified for
this disease, the role of immune inflammatory factors
such as IL-1 and TNF alpha is almost apparent [5]. That
is why new biologic drugs including anti-TNF (infliximab,
Abstract The aim of this study was to evaluate the effectiveness
and cost-effectiveness of using rituximab as first
line for patients with refractory rheumatoid arthritis in
comparison with continuing conventional DMARDs, from
a perspective of health service governors. A systematic
review was implemented through searching PubMed, Scopus
and Cochrane Library. Quality assessment was performed
by Jadad scale. After meta-analysis of ACR index
results, QALY gain was calculated through mapping ACR
index to HAQ and utility index. To measure the direct and
indirect medical costs, a set of interviews with patients
were applied. Thirty-two patients were selected from three
referral rheumatology clinics in Tehran with definite diagnosis
of refractory rheumatoid arthritis in the year before
and treatment regimen of either rituximab or DMARDs within last year. Incremental cost-effectiveness ratio was
calculated for base case and scenario of generic rituximab.
Threefold of GDP per capita was considered as threshold
of cost-effectiveness. Four studies were eligible to be
considered in this systematic review. Total risk differences
of 0.3 for achieving ACR20 criteria, 0.21 for ACR50 and
0.1 for ACR70 were calculated. Also mean of total medical
costs of patients for 24 weeks were $3985 in rituximab
group and $932 for DMARDs group. Thus, the incremental
cost per QALY ratio will be $45,900–$70,223 in base
case and $32,386–$49,550 for generic scenario. Rituximab
for treatment of patients with refractory rheumatoid arthritis
is not considered as cost-effective in Iran in none of the
scenarios.
Keywords Rheumatoid arthritis · Cost-effectiveness ·
Rituximab · Iran