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薬理と治療
Abstract
Background Rheumatoid arthritis (RA) is accompanied by a large societal economic burden. The cost-effectiveness of treatment with specific sequences of biologic agents(biologics)based on trials has been investigated; however, such studies have not adequately considered biologics utilization under real-life conditions, in which treatment conditions were not highly controlled and various sequences of biologics were used. Therefore, the cost-effectiveness of selecting any biologics was investigated using the RA cohort database of the Institute of Rheumatology, Rheumatoid Arthritis(IORRA). Methods A state-transition model-based probabilistic simulation from a societal perspective was conducted. Model parameters were determined using clinical data from 421 patients from the IORRA who had failed at least one disease-modifying anti-rheumatic drug (DMARD)and started either one of four biologics(adalimumab, etanercept, infliximab, and tocilizumab)or methotrexate between April 2008 and April 2011. Patients had no history of biologics use and were matched using the propensity score. A hypothetical population of 10000 patients treated with sequences of three biologics following methotrexate and then best supportive care(BSC), were compared to those starting methotrexate following BSC. Because tocilizumab differs from other biologics in mechanism and showed large decrease of drug price in 2012 in Japan, sequences of three of four biologics(adalimumab, etanercept, infliximab, and tocilizumab)and three of them except for tocilizumab were also considered. Results Clinical data from the IORRA showed no significant differences in disease duration, J-HAQ, EQ-5D, or other patient backgrounds between the matched patients. The incremental cost-effectiveness ratio of treatment sequences with biologics was ¥3817971 or ¥4885450 including tocilizumab or not, respectively, and with more than 80% probability of falling below assumed thresholds of ¥5400000 according to probabilistic sensitivity analysis. Interpretation Biologics are cost-effective for RA patients who failed at least one DMARD based on data from an observational cohort representing daily clinical practice in Japan.
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