PMS8 Cost-Effectiveness analysis of Etanercept versus Available anti-Tnf and Il-6 Blockers for Treating Rheumatoid Arthritis in Guatemala

PMS35 COST-EFFECTIVENESS ANALYSIS OF ETANERCEPT VERSUS AVAILABLE ANTI-TNF AND IL-6 BLOCKERS FOR TREATING RHEUMATOID ARTHRITIS IN HONDURAS Lutz MA1, Alonzo H2, Bogantes JP1, Cuesta G3 1Pfizer Central America and the Caribbean, San Jose, Costa Rica, 2Hospital de Especialidades del Seguro Social, Tegucigalpa, Honduras, 3Pfizer Central America and the Caribbean, Escazu, San Jose, Costa Rica OBJECTIVES: Approximately 0.4% of the Latin American population over 16 years old is affected by Rheumatoid Arthritis (RA). RA has an important economic and social impact due to its chronic and progressive condition. The objective is to assess the cost-effectiveness (CE) of etanercept in the treatment for moderate to severe RA, among patients failing antirheumatic drugs, in comparison with the rest of anti-TNF and IL-6 blockers available in Honduras, from the health care payer’s perspective. METHODS: A decision-tree model was implemented to compare the costs and effectiveness of etanercept (comparator, 50mg/week), adalimumab (40mg/15 days), infliximab (3-10mg/kg), rituximab (1000mg day 0 and 15, week 16-24) and tocilizumab (8mg/kg/month), all in combination with methotrexate, in the treatment of RA in adult population of Honduras. The effectiveness measures were: American College of Rheumatology (ACR) Response Criteria ACR<20 and ACR<70. Quality utilities were obtained from Health Assessment Questionnaire (HAQ). Local costs (2012 US$) were obtained from Official Social Security databases of Honduras. The outcomes were: total costs of RA (adverse events, exams and treatments) and QALYs gained. Univariate sensitivity analysis was performed. The time horizon was 2 years and the discount rate was 5% for costs and health outcomes. RESULTS: The total cost of etanercept was $US39,788.57, being $US1,149.43, $US3,131.82 $US6,622.29, and $US16,616.10 less expensive than tocilizumab, rituximab, adalimumab, and infliximab, respectively. Etanercept also gained the highest number of QALYs (1.5423) in comparison with adalimumab (1.5048), infliximab, (1.4299), rituximab (1.4674), and tocilizumab (1.4955). Cost-effectiveness analyses showed etanercept as the dominant strategy. Acceptability curves showed that at the willingnessto-pay level of US$8,000/QALY, etanercept was cost-effective with a 100% probability. PSA results support the robustness of these findings. CONCLUSIONS: This is the first CE study for RA developed in Honduran population. Etanercept appeared as the most cost-effective alternative for RA compared to other antiTNF and IL-6 blockers.