Cost-Minimization Analysis Of Anti-Tnf Biologics In The Treatment Of Rheumatoid Arthritis, Ankylosing Spondylitis And Psoriatic Arthritis Under The Brazilian Private Health Care System Perspective

Abstract

Objectives: To compare the treatment cost of anti-TNF biologics indicated simultaneously for the treatment of rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) under the Brazilian private health care system perspective. Methods: In Brazil, four anti-TNF biologics are approved for the treatment of RA, AS and PsA: adalimumab (ADA), etanercept (ETA), infliximab (IFX), and golimumab (GOL). Published literature shows no difference in safety and efficacy among them; therefore, a cost-minimization analysis was performed as presented by Morais AD et al at ISPOR 18th Annual Meeting. Yearly treatment costs were calculated for an average patient of 70 kg, according to dose and dosing intervals defined in products label. Prices were gathered from the official price list. Since IFX dose is weight-dependent, deterministic sensitivity analysis (DSA) was conducted to determine the impact of this parameter on results. Results: GOL has the lowest cost of treatment across the biologics in all indications, at R$41,555 per patient per year. GOL treatment cost remains unchanged across indications or years of treatment, as loading dose is not required. For RA treatment, IFX has the second lowest cost of treatment at R$60,720/patient/year. For AS and PsA treatments, due to higher dosing of IFX, the average cost per patient is R$80,960, similar to the cost with ADA and 8.8% above ETA. Using DSA, cost of treatment with IFX for AS and PsA can reach up to R$101,199, assuming a patient weight of 100 kg. Conclusions: Treatment with GOL compared to the other anti-TNFs may bring important savings to the private payers (HMOs), not only in RA, but also in AS and PsA, with potential to reduce the cost of treatment by 48.7%, and so allowing a higher number of patients to be treated at same budget level.