The selective costimulation modulator abatacept is cost-effective in the treatment of patients with moderate-to-severe rheumatoid arthritis (RA), investigators report in the Journal of Rheumatology.
Dr. Gerry Oster of Policy Analysts, Inc., of Brookline, Massachusetts, and colleagues developed a simulation model to depict progression of disability in a hypothetical cohort of 1,000 women aged 55-64 years with moderately to severely active RA and inadequate response to tumor necrosis factor alpha-antagonists.
At baseline, patients were assumed to receive either oral disease modifying antirheumatic drugs (DMARDs) only or oral DMARDs plus abatacept. Patients were then tracked from model entry until death.
Cost-effectiveness was expressed in terms of incremental cost, in 2006 US dollars, per quality-adjusted life year (QALY) gained over 10 years and over a lifetime.
Abatacept would yield 1.0 additional QALY per patient over ten years, with 4.0 QALY for abatacept compared with 3.0 QALY for oral DMARDs alone. Over a lifetime, the additional QALY gained was 1.6.
Cost-effectiveness was ,576 per QALY gained over 10 years, and ,979 per QALY gained over a lifetime, Dr. Oster and colleagues report in the September issue of the Journal.
"Abatacept is cost-effective by current standards of medical practice in patients with moderately to severely active RA and inadequate response to an anti-TNF," the investigators conclude.
"I don't believe that (abatacept) is more cost-effective than other biologic response modifiers," Dr. Oster told Reuters Health. "A particular drug works for one person, but not another, and vice versa. So, rheumatologists like to have lots of 'bullets in their gun,' that is, drugs from which to choose."
"The question is whether any new medication -- in this instance, abatacept -- provides value for money relative to other treatments widely used in the patient population of interest. Our study answers that question in the affirmative with respect to abatacept."
J Rheum 2008;35:1745-1753.