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LAS VEGAS -- The tumor necrosis factor inhibitor etanercept (Enbrel) was more cost-effective for the treatment of rheumatoid arthritis than were two other biologic agents in this class, a budget impact analysis found.

The total annual cost of treatment with etanercept, including screening, monitoring, and treating adverse events, was $22,562, according to Alicia M. Picard, PharmD, of Northeastern University in Boston.

In comparison, a year's treatment with infliximab (Remicade) was $38,036 and the cost for adalimumab (Humira) was $43,948, she reported in a poster session at the midyear clinical symposium of the American Society of Health-System Pharmacists.

The Massachusetts Medicaid program, MassHealth, requires prior authorization for any of the biologic therapies now in use for treating rheumatoid arthritis, including documentation of the diagnosis and any inadequate response or adverse reaction to at least one conventional disease-modifying anti-rheumatic drug.

"To help inform decision-makers in their formulary choices, we conducted a clinical and economic evaluation to determine whether etanercept was a cost-effective choice," Picard explained in an interview with 番茄社区app.

In the clinical evaluation, she and her colleagues found that in two large studies, etanercept plus methotrexate was more effective than methotrexate alone in clinical responses and in inhibiting progression of joint damage.

Then, to examine the economic evidence, they identified two retrospective observational studies, both of which found etanercept to be less costly than infliximab or adalimumab.

Finally, in their budget impact analysis, they calculated the total using assigned predetermined costs for the medication itself, for lab tests, and for treating adverse events.

Annual estimated cost of the medications were $20,400 for etanercept, $21,600 for adalimumab, and $36,000 for infliximab.

Costs associated with the treatment of adverse events had a notable impact on the overall total, the analysis revealed.

For instance, the cost of treating a patient for tuberculosis was estimated at $1,686, and patients receiving infliximab or adalimumab had a 3.5-fold increased risk of developing tuberculosis compared with those on etanercept.

Adalimumab-treated patients had a 5% chance of experiencing a significant cardiovascular event, which was not seen for etanercept, and costs associated with treatment for these events were estimated at $20,058.

And while patients on etanercept had twice the risk of any infection compared with patients receiving the other agents, treatment of a routine infection was estimated at $16.

An additional cost for infliximab was the FDA-mandated requirement for co-administration of methotrexate, which is not required for the other agents.

These calculations suggest that etanercept would be an appropriate choice for the MassHealth formulary, with no restrictions, Picard concluded.

However, further cost-effectiveness analyses would be useful, because other new options for the treatment of refractory rheumatoid arthritis are now available.

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