Tocilizumab after a first-line with anti-TNF in rheumatoid arthritis: a cost-consequence analysis in the Italian setting.

Objectives: Switching to a different mechanism of action in rheumatoid arthritis (RA) patients after a first anti-TNF-α has proved to be effective. The objective of this study was a health economic assessment in Italy.

Methods: The study was conducted using a pharmacoeconomic model with a 3-year time horizon. Effectiveness was measured as days gained in low disease activity (LDA; DAS28-ESR <3.2) or in remission (DAS28-ESR <2.6). The model simulated the response to treatments, based on the Rotation Or Change (ROC) trial, the probability of discontinuation and switch to a 3rd-line biologic, and the transition to death. Time on treatment curves for 2nd-line biologics were derived from published Italian real-word data. Costs were estimated based on published sources and Italian prices and tariffs.

Results: The switch to tocilizumab after the failure of a first anti-TNF-α was more effective than a second anti-TNF-α, in terms of days in remission (224 vs. 114 days) and of days in LDA (345 vs. 193 days). The cost-consequence ratio with tocilizumab iv was 174 euros/day in remission and 113 euros/day in LDA. With tocilizumab sc the ratio was 181 euros/day in remission and 117 euros/day in LDA. The same ratios for the anti-TNF-α treatments ranged from 233 to Euro 320 euros per day in remission and from 138 to 190 euros per day in LDA.

Conclusions: The switch to a different mechanism of action, namely tocilizumab, after the failure of a first anti-TNF-α agent seems a rational strategy for RA patients in the Italian setting.