A recent study found that from a US payer’s perspective tocilizumab (TCZ) mono therapy is more cost-effective when compared with adalimumab (ADA) monotherapy in patients with severe rheumatoid arthritis for whom methotrexate is not indicated.
Rheumatoid arthritis (RA) is a chronic autoimmune disease that leads to severe inflammation in joints and connective tissue, along with other systemic effects. The condition has a serious economic and health-related quality-of-life impact.
Tocilizumab (TCZ), a humanized monoclonal antibody that inhibits the interleukin-6 receptor, has been found to be a safe and effective combination with methotrexate (MTX) in patients with RA with insufficient response to traditional agents. For patients who cannot tolerate MTX, a recent study found that an anti-TNF-α drug, adalimumab, is effective for those RA patients.
To examine the cost effectiveness of tocilizumab (TCZ) monotherapy (Mono) versus adalimumab monotherapy, Josh Carlson from the University of Washington in collaboration the Genentech and F. Hoffmann-La Roche compared the two drugs using efficacy results from a study called ADACTA.
In their study titled “Economic Evaluation of Tocilizumab Monotherapy Compared to Adalimumab Monotherapy in the Treatment of Severe Active Rheumatoid Arthritis” published in the journal Value in Health, the researchers analyzed within a time-frame of 6 months the incremental cost per responder (achievement of American College of Rheumatology [ACR] 20% improvement criteria, ACR 50% improvement criteria, ACR 70% improvement criteria, or low disease activity score) for TCZ versus ADA .
Results revealed that compared with ADA, TCZ was more effective, with an estimated incremental cost at 6-months ranging from $6,570 per additional low disease activity score achiever to $14,265 per additional ACR 70% improvement criteria responder. Estimations of the lifetime cost-effectiveness of TCZ Mono compared with ADA Mono were $36,944 per QALY gained. The lifetime ICER and the short-term ICERs (e.g., $13,351/ACR20 response) are consistent with cost-effectiveness ratios reported for other biologic agents in similar populations.
Based on these results, the researchers concluded that from a US payer’s perspective, TCZ (8 mg/kg every 4 weeks) Mono is more effective and cost-effective when compared with ADA Mono 40 mg EOW and superior when compared with ADA Mono 40 mg weekly in patients with severe RA for whom MTX is not indicated.