Dr. Feldman serves on the data safety monitoring board for Novartis.
Cost-effectiveness of biologics in polyarticular-course juvenile idiopathic arthritis patients unresponsive to disease-modifying antirheumatic drugs†
Article first published online: 28 DEC 2010
Copyright © 2011 by the American College of Rheumatology
Arthritis Care & Research
Volume 63, Issue 1, pages 111–119, January 2011
How to Cite
Ungar, W. J., Costa, V., Hancock-Howard, R., Feldman, B. M. and Laxer, R. M. (2011), Cost-effectiveness of biologics in polyarticular-course juvenile idiopathic arthritis patients unresponsive to disease-modifying antirheumatic drugs. Arthritis Care Res, 63: 111–119. doi: 10.1002/acr.20337
The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by the Ontario Ministry of Health and Long-Term Care is intended or should be inferred.
- Issue published online: 28 DEC 2010
- Article first published online: 28 DEC 2010
- Accepted manuscript online: 25 AUG 2010 03:01PM EST
- Manuscript Accepted: 16 AUG 2010
- Manuscript Received: 10 MAR 2010
- Program grant from the Ontario Ministry of Health and Long-Term Care Drug Innovation Fund
- Hospital for Sick Children Research Institute
- Canada Research Chair in Childhood Arthritis
Juvenile idiopathic arthritis (JIA) is the most common chronic pediatric rheumatic disease and can have long-term effects leading to disability in adulthood. Biologics are a new class of drugs increasingly used to treat JIA. The primary study objective was to determine the incremental costs of biologics per additional responder compared to conventional treatment (methotrexate).
A separate decision model was created for etanercept, infliximab, adalimumab, and abatacept. The study population consisted of polyarticular-course JIA patients with a prior inadequate response or intolerance to disease-modifying antirheumatic drugs (DMARDs). The effectiveness measure was the proportion of patients who had a treatment response at 1 year according to the American College of Rheumatology (ACR) Pediatric 30 (Pedi 30) improvement criteria. Direct and indirect costs were calculated in 2008 Canadian dollars. Incremental cost-effectiveness ratios and 95% confidence intervals (95% CIs) were calculated for each biologic agent using probabilistic sensitivity analyses.
The additional costs per additional ACR Pedi 30 responder at 1 year were $26,061 (95% CI $17,070, $41,834), $46,711 (95% CI $30,042, $75,787), $16,204 (95% CI $11,393, $22,608), and $31,209 (95% CI $16,659, $66,220) for etanercept, adalimumab, abatacept, and infliximab, respectively.
Biologics are more effective than methotrexate in achieving a short-term response in JIA patients with prior inadequate responses to DMARDs; however, this comes at a high annual cost. Adequate long-term data with respect to both safety and effectiveness are not currently available, nor are utility estimates. Such data will be important to estimate value for money for treating JIA with biologic drugs over the long term.