Little Benefit to Etanercept-MTX Before Triple Therapy in Rheumatoid Arthritis

HealthDay News — For patients with rheumatoid arthritis, first-line etanercept-methotrexate is associated with increased costs compared with triple therapy, while providing minimal benefit, according to a cost-effectiveness analysis published online May 30 in the Annals of Internal Medicine.

Nick Bansback, PhD, from the University of British Columbia in Vancouver, Canada, and colleagues examined the cost-effectiveness of etanercept-methotrexate in a within-trial analysis based on 353 participants in the Rheumatoid Arthritis Comparison of Active Therapies trial, and a lifetime analysis extrapolating costs and outcomes.

The researchers found that use of etanercept-methotrexate as first-line therapy was associated with marginally more quality-adjusted life-years (QALYs) but substantially higher drug costs. Negligible differences were seen between strategies in other costs. For first-line etanercept-methotrexate and triple therapy, the incremental cost-effectiveness ratios were $2.7 and $0.98 million per QALY over 24 and 48 weeks, respectively. First-line etanercept-methotrexate was found to result in a 0.15 additional lifetime QALY in lifetime analysis; this gain would cost an incremental $77,290, resulting in an incremental cost effectiveness ratio. of $521,520 per QALY per patient.

“Considering a long-term perspective, an initial strategy of etanercept-methotrexate and biologics with similar cost and efficacy is unlikely to be cost-effective compared with using triple therapy first, even under optimistic assumptions,” the authors wrote. Therefore, “initiating biologic therapy without trying triple therapy first increases costs while providing minimal incremental benefit.”

Several authors disclosed financial ties to the pharmaceutical industry.

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Bansback N, Phibbs CS, Sun H, et al. Triple therapy versus biologic therapy for active rheumatoid arthritis: a cost-effectiveness analysis [published online May 30, 2017]. Ann Intern Med. doi:10.7326/M16-0713

Losina E, Katz JN. Improvement at any cost? The art and science of choosing treatment strategies for rheumatoid arthritis [published online May 30, 2017]. Ann Intern Med. doi:10.7326/M17-1176