Objectives: Rheumatoid Arthritis (RA) is a chronic systemic autoimmune disease which affects around 0.5% of adult population worldwide. ADACTA (Gabay et al, 2012) is the first study designed to compare two approved biologic drugs in monotherapy for the treatment of RA. The trial compared tocilizumab monotherapy (TCZ) vs. adalimumab monotherapy (ADA) and presented results that support TCZ alone as a single-agent therapy for RA patients who are either intolerant to methotrexate (MTX) or in whom previous MTX therapy was inadequate. Based on ADACTA, this study aims to compare annual costs per clinical remission of TCZ vs. ADA in moderate/severe adult RA treatment considering ACR70 and DAS28 outcomes. Methods: Remission data of ACR70 and DAS28 outcomes were taken from ADACTA study. Annual costs of TCZ and ADA therapies considered labeled dosage and public drugs acquisition's prices. Based on these data, costs per clinical remission after one year of treatment were compared. Regimen was 8 mg/kg every 4 weeks TCZ and 40 mg every 2 weeks ADA. The average weight of 67 kg was assumed. A public health care system perspective was considered and only drug costs were evaluated. Drug acquisition prices were assessed from public disclosures. Costs were reported in Brazilian Reais (BRL1.00= USD0.51 Feb/2013). Results: After one year of treatment, annual costs were BRL26,898.56 ADA and BRL19,945.90 TCZ. Therapy with TCZ as a single-agent showed better response rates in both outcomes (ACR70 32.50% TCZ vs. 17.90% ADA and DAS28 39.90% TCZ vs. 10.50% ADA). Costs per clinical remission considering ACR70 results were BRL61,372.00 TCZ vs. BRL150,271.28 ADA. Costs per clinical remission of DAS28 were BRL49,989.72 TCZ vs. BRL256,176.76 ADA. Conclusions: The analysis suggests that TCZ represents an effective strategy to treat moderate/ severe adult RA patients in Brazil's public health care system and presents lower costs per clinical remission compared to ADA.
Buschinelli, C. T., Maximo, M. F. M., Tsuchiya, C. T., Tobaruella, F. S., & Gonçalves, T. M. (2013). Analyzing Costs Per Clinical Remission of Tocilizumab Monotherapy Versus Adalimumab Monotherapy in Rheumatoid Arthritis from a Public Perspective in Brazil. Value in Health, 16(7), A716. https://doi.org/10.1016/j.jval.2013.08.2217