A post-hoc analysis of the head-to-head, randomized Abatacept versus Adalimumab Comparison in Biologic-Naïve RA Subjects with Background Methotrexate (AMPLE) trial demonstrated that subcutaneous (SC) abatacept treatment showed improved efficacy versus SC adalimumab in patients with seropositive, erosive early rheumatoid arthritis (RA). Given the considerable economic burden posed by RA that is largely attributed to biologic disease-modifying antirheumatic drugs, cost-per-responder analyses allow more efficient allocation of economic resources.
The analysis used a previously described decision tree to compare the cost per response and per patient in remission for abatacept and adalimumab in a cohort of 1000 patients from 4 countries—the United States, Canada, Germany, and Spain—over a 2-year period. Patients with or without seropositive, erosive early RA from the post-hoc analysis of the AMPLE trial, who were defined as disease duration ≤6 months, rheumatoid factor or anticitrullinated protein antibody seropositive, and with >1 radiographic erosion were included. Response assessment was based on American College of Rheumatology 20%/50%/70%/90% improvement criteria (ACR20/ACR50/ACR70/ACR90), and Health Assessment Questionnaire Disability Index (HAQ-DI). Direct medical costs of adverse events were based on local tariffs for disease-related groups, and drug costs were obtained from ex-manufacturer price, including mandatory reductions, payback, and transparent discounts for drugs.
For ACR20, ACR50, ACR70, ACR90, and HAQ-DI responses assessed in this analysis, the cost per response in patients with seropositive, erosive early RA favored SC abatacept compared with SC adalimumab across all countries. Moreover, in both subgroups with or without seropositive, erosive early RA, cost per ACR90 and HAQ-DI response consistently favored SC abatacept in all countries. In the United States, compared with adalimumab, the monthly cost per responding patient for abatacept in erosive early RA was −$918 for ACR20, −$1352 for ACR50, −$4175 for ACR70, −$124,174 for ACR90, and −$363 for HAQ-DI. In terms of cost per remission, for patients with seropositive, erosive early RA in all countries, the cost per Clinical Disease Activity Index (CDAI) and Simple Disease Activity Index (SDAI) remission also favored SC abatacept. However, in the United States and Canada, the cost per Disease Activity Score-28 (DAS28) remission favored SC adalimumab. In the United States, the monthly cost per patient in remission in erosive early RA was +$622 for DAS28, −$8015 for CDAI, and −$8015 for SDAI. For patients without seropositive, erosive early RA, the results were less favorable for SC abatacept for most countries, except in Germany and Spain, where the cost of abatacept is lower than the cost of adalimumab.
The findings of this cost-per-responder analysis support the cost-efficiency benefit of SC abatacept compared with SC adalimumab in patients with seropositive, erosive early RA in the United States, Germany, Spain, and Canada.
Foo J , et al. ACR 2017. Abstract 1465.