Several economic modeling and analysis techniques exist comparing different therapeutic strategies following lack of response with tumor necrosis factor inhibitor (TNFi) in patients with rheumatoid arthritis (RA), but a uniformed methodology is needed to report economic evaluations of cycling vs swapping after TNFi, according to study results published in Arthritis Care & Research.

In this systematic review, researchers searched major databases for studies comparing the cost-effectiveness of 2 different therapeutic approaches commonly used after TNFi failure in patients with RA: switching to a therapy with a different mechanism of action or using an alternative TNFi. After applying the search criteria, the investigators found 7 studies, which consisted of 19 comparisons. The majority of economic models included a lifetime horizon, came from a payer perspective, used a 6-month cycle duration, and measured treatment efficacy with American College of Rheumatology improvement criteria.

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After analysis, the researchers found a broad range of study designs, major assumptions, and model structures, which greatly affected individual study results. In addition, the team reported that the median incremental cost-effectiveness ratio was $70,332 per quality-adjusted life year for the 2 treatment approaches. In addition, data show that rituximab was more effective and less expensive than TNFi in most comparisons and intravenous abatacept vs TNFi was less cost-effective than rituximab.

“Common influential parameters in sensitivity analyses were the rituximab dosing schedule, assumptions regarding disease progression, and estimation of utilities,” the researchers wrote.


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The primary study limitation was the intrinsic heterogeneity in the economic evaluations.

“Future research should determine the treatment sequences used in real-world clinical practice and the length of time patients continue taking each agent,” they concluded.

Reference

Karpes AR, Suarez-Almazor ME, Cantor SB, et al. Systematic review of economic evaluations of cycling versus swapping in patients with rheumatoid arthritis after failure to tumor necrosis factor inhibitors [published online February 23, 2019]. Arthritis Care Res. doi:10.1002/acr.23859