Cost-effectiveness analysis of tocilizumab as first-line biological treatment for patients with rheumatoid arthritis, from the perspective of Brazilian public healthcare system (SUS)

Abstract

Objective: This evaluation aimed to determine the cost-effectiveness of tocilizumab in monotherapy as first-line biological treatment for patients with rheumatoid arthritis (RA), from the perspective of the National Health System of Brazil (SUS). Method: A cost-effectiveness model was developed to follow patients after synthetic disease-modifying anti-rheumatic drugs (sDMARD) treatment failure, during a 24-weeks follow-up. The base scenario evaluated the direct comparison of tocilizumab versus adalimumab due to existence of a head-to-head study. The secondary scenario evaluated tocilizumab versus certolizumab pegol and etanercept indirectly through a meta-analysis of indirect comparison, due to the absence of head-to-head studies. The estimate of total direct medical costs for the RA treatment was developed by expert opinion and collected from secondary databases. Results: The result of the model’s baseline scenario showed gains in effectiveness with lower treatment cost, resulting in a dominant ratio of incremental cost effectiveness (ICER). The secondary scenario result, showed that tocilizumab was more effective than their comparators, indicating a need for investment when compared to certolizumab, varying between R$ 1,449.46 and R$ 18,934.62, and with a dominant ICER when compared to etanercept. Conclusion: This analysis concludes that tocilizumab monotherapy has clinical and economic benefits in the treatment of RA in patients who cannot maintain therapy with synthetic MMCD and also offers alternatives to health systems as regards allocation of resources for system sustainability.