Objectives: Effective treatment with biologic DMARDs poses a significant economic burden. Recent subgroup analyses showed improved efficacy for abatacept in serum anti-citrullinated protein antibody (ACPA)-positive patients, with increasing efficacy across ACPA quartile levels. The aim of the study was to evaluate the cost per response of abatacept relative to adalimumab in ACPA-positive patients with RA from the Italian societal perspective. Methods: A decision tree was designed to compare the cost per response of abatacept with adalimumab in a cohort of 1000 ACPA-positive patients over 2 years. Clinical inputs were based on the Abatacept versus Adalimumab Comparison in Biologic-Naive RA Subjects with Background Methotrexate AMPLE trial, and response was based on ACR20/50/70/90 and HAQ-DI. Unit costs for direct medical costs of AEs were based on Italian tariffs for diseaserelated groups and the ex-manufacturer's price, including mandatory reductions, payback and transparent discounts for drugs. Societal costs included patient costs, indirect costs of work absence and early retirement, according to HAQ functional capacity categories. Results: Cost per response in ACPA-positive patients in Italy favoured abatacept compared with adalimumab (- € 154 for ACR20, - € 6,426 considering ACR90 and - € 281 for HAQ-DI). Cost per remission favoured abatacept in ACPA-positive patients with a cost reduction per CDAI and SDAI equal to € 744 and € 1,310 respectively. Abatacept was consistently favoured in ACPA-Q4 patients across all outcomes in Italy. Conclusions: The cost per selected outcome in ACPA-positive patients favoured SC abatacept compared with SC adalimumab. The costs per all outcomes were lower for SC abatacept than SC adalimumab in ACPA-Q4 patients in Italy. Cost savings were greater when more stringent response criteria were applied and also with increasing ACPA levels, which could lead to a lower overall healthcare budget impact with abatacept compared with adalimumab in Italy.
Foo, J., Mennini, F., Rodriguez Heredia, J., Choquette, D., Attinà, G., Merino, J., … Gaultney, J. (2017). Cost Per Response for Abatacept Compared with Adalimumab In the Treatment of Patients with Rheumatoid Arthritis Based on Anti-Citrullinated Protein Antibody Titres In Italy. Value in Health, 20(9), A531. https://doi.org/10.1016/j.jval.2017.08.751