Cost-Effectiveness Analysis of Etanercept in Combination with Methotrexate for Rheumatoid Arthritis - Markov Model Based on Data from Serbia

Abstract

Biological therapeutic strategies have shown positive benefits for chronic and progressive rheumatoid arthritis (RA) in clinical and radiological outcomes. Despite these results, the use of biological drugs in the treatment of RA is limited by high costs. The aim of this study was to compare the cost effectiveness of etanercept in combination with methotrexate and methotrexate alone in patients with RA in the socioeconomic environment of a Balkan country.We conducted a cost-effectiveness study using a Markov model from a societal perspective with a time horizon of 480 months. The cycle duration was set to one month. The basic transition probabilities and data on therapeutic efficacy were estimated from the available literature, while costs were calculated using the medical documents of patients with RA treated at the Clinical Center Kragujevac.Our results indicated that treatment of patients with RA using methotrexate alone is more cost effective, with a cost-effectiveness ratio of 1.446.640,78 RSD/QALY, than treatment with a combination of methotrexate and etanercept, with a cost-effectiveness ratio of 5.882.714,57 RSD/QALY.The use of etanercept to treat RA is not cost effective in the socioeconomic environment of Serbia. The cost-effectiveness ratio of biological drugs would be more favourable if special strategies for the pricing policy of biological drugs were established on the basis of local pharmacoeconomic studies.