Economic Evaluation Of Abatacept Vs Adalimumab For The Treatment Of Patients With Moderate To Severe Rheumatoid Arthritis

Background:Rheumatoid arthritis is an autoimmune disease with erosive arthritis as the main clinical manifestation.It can occur at any age and the global incidence rate ranges from 0.5%to 1%.In mainland China,the incidence rate is about 0.28%and the prevalence rate is about 0.42%,and the total number of patients is about 5 million.The pathological characteristics of rheumatoid arthritis determine the gradual impact on patients and bring huge economic burden to patients and society.Rheumatoid arthritis in China mainly presents four characteristics,that is,many patients,many delayed diagnosis and treatment,many moderate and severe patients and many complicating diseases.The status quo of treatment is "two highs and two lows",that is,the utilization rate of non-steroidal anti-inflammatory drugs and glucocorticoids is high,and the utilization rate of methotrexate,biological agents and small molecule targeted drugs is low.The problem of nonstandard drug use needs to be solved urgently.In recent years,with the vigorous development of pharmacoeconomics,the evaluation results of pharmacoeconomics have gradually become the basis for the scientific formulation and adjustment of healthcare policies.Abatacept is a newly listed biological agent in China,which is different from other antirheumatic drugs in its mechanism of action.There is no pharmacoeconomic research on this drug in China so far,so it is necessary to conduct economic evaluation to measure its cost-effectiveness and the possibility of being included in basic medical insurance system.Objective:To assess the cost-effectiveness of abatacept compared with adalimumab in rheumatoid arthritis patients with anti-citrullinated Protein Antibodies(ACPA)positives.To predict the impact of abatacept on the fund after being covered by the basic medicial insurance system.To provide more drug choices for decision maker and further improve the quality of life and reduce economic burden of patients.Methods:A lifetime-Markov model with and adopting the perspective of the Chinese public healthcare system was used to assess cost-effectiveness of abatacept.Effectiveness parameters came from public direct comparative clinical trials abroad,cost parameters came from Chinese public data.Incremental cost-utility was the main research indicator.In order to test the robustness of the model and parameters,the one-way sensitivity analysis was undertaken according to the range of discount rate of 0%～8%and other indexes of ±10%.Undertake probabilistic sensitivity analysis according to the setting that the cost parameter obeys Gamma distribution and the utility parameter obeys Beta distribution.In the budget impact analysis,from the perspective of China’s medical payer,based on the analytical framework of ISPOR and China’s Pharmaceutical Economic Evaluation Guide,the budget impact analysis model was constructed by Excel 2013.Taking 2021 as the baseline year,predict the impact of abatacept on the fund after being covered by the basic medicial insurance system from 2022 to 2024.The main research indicator is the increment of medical insurance fund.To test the robustness of the model and parameters,sensitivity analysis was conducted by reducing the drug price of abatacept by 20%,30%and increasing or decreasing the market share by 20%respectively.Results:Incremental cost-utility value obtained by incremental analysis in cost-utillity was 177204,which was 2.45 times of GDP per capita(72447 yuan in 2020).In the one-way sensitivity analysis,the most influential factors were the cost of abatacept and the EQ-5D of the state which patients have EULAR response to abatacept or adlimumab.In the probability sensitivity analysis,when the willingness to pay was 72760 yuan,the economic probability of abatacept and adalimumab was equal.When the willingness to pay was 3 times GDP per capita,the probability of abatacept being economical is 95%.The budget impact analysis results show that,in the next three years,the incremental medical insurance fund expenditure is 0.95、0.97 and 0.88 million yuan respectively after abatacept is covered by the basic medicial insurance system.Sensitivity analysis results show that the price of abatacept has larger influence on the difference between the medical insurance fund expenditure.Conclusions:Using the recommended willingness to pay threshold of 1-3 time per capita GDP,abatacept is cost-effective compared to adalimumab for the treatment of ACPA-positive in patients with rheumatoid arthritis.Abatacept has little impact on our medical insurance fund.More patients will benefit from abatacept after it is covered by the basic medicial insurance system.