Cost-EffectivenessAnalysisofTocilizumabinComparisonwith Infliximab inIranianRheumatoidArthritisPatientswith Inadequate ResponsetotDMARDs:AMultistageMarkovModel


Abstract: To analyzethecost-effectivenessoftwocommontreat- ment strategiesinIran,comparinginfliximab plusmethotrexatewith tocilizumab plusmethotrexateinpatientswithrheumatoidarthritis with inadequateresponsetotraditionaldisease-modifyinganti- rheumatic drugs. Methods: A multistageMarkovdecisionmodel was appliedtoassesstheincrementalcost-effectivenessratio(ICER) of atocilizumab-containingregimenversusaninfliximab-containing regimen overa5-yeartimeperiod.Inthecaseofnoresponse,we assumed thatpatientsswitchedtothenexttreatment(adalimumab, rituximab, orsupportivecare)insequenceforeachstrategy.We consideredmajorcostitems,suchasdirectmedicalcostsanddirect nonmedical costs,fromapayer(patientsandthird-partypayers) perspective.Adeterministicsensitivityanalysiswasconductedto assess therobustnessofthemodelresultsovertheuncertaintyofkey parameters. Results: In thebase-caseanalysis,theICERofthe tocilizumab-containingregimenwasUS$60,800perquality-adjusted life-year ascomparedtotheinfliximab-containingregimen.In the sensitivityanalysis,changesinthepriceofthedrugsby generic substitution,inutilityscores,andindiscountratedidnot change ouroverallconclusions.Amongallinputstotheprimary study andthesensitivityanalyses,however,thepriceoftocili- zumab hadthemostimpactontheICER. Conclusions: Although tocilizumab andmethotrexateprovidealargergaininquality- adjusted life-years,theircurrentpriceisquitehighascomparedwith those ofourotherinterventions.Therefore,aregimencontaining tocilizumab isnotcost-effectiveascomparedwithaninfliximab- containingregimenforpatientswithrheumatoidarthritisinIran. Keywords: cost-effectiveness,infliximab, Iran,rheumatoidarthritis, tocilizumab. Copyright & 2015,




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