Budget impact model of rituximab after failure of one or more TNFα inhibitor therapies in the treatment of rheumatoid arthritis

Objectives: To estimate the budget impact implied by the introduction of rituximab after failure of one or more anti-TNF alpha therapies in the perspective of the French health care system. Methods: A Markov model reproduced the course, over 4 years, of patients treated either by infliximab, etanercept, adalimumab or RTX, after failure of one or more anti-TNF alpha therapies, in a multicentric study. A sensitivity analysis was developed to account for patients in 3rd and subsequent lines of treatment who are expected to consume more healthcare resources. Results: When RTX is not used, total annual medical cost is (sic)16,555 per patient, (sic)13,206 of which are dedicated to drug acquisition. When RTX is the only treatment in use, these costs decrease respectively to (sic)11,444 and (sic)7469. Total savings per patient and per year is (sic)5000. Over 4 years, total savings for the targeted population reach (sic)118 M. In the sensitivity analysis, the difference between H2 and H2-coeff 2 (20%) reaches (sic)5,400,000 in total direct costs during the first year of simulation. This difference decreases along the period, to reach (sic)2,400,000 the fourth year of simulation, and is due to the fact that rituximab acquisition costs are independent from the treatment line. Conclusion: If TNF alpha inhibitors were the only treatment available, the annual global cost of treatment would be (sic)16,555 per patient versus (sic)11,444 for patients treated exclusively with rituximab. RTX is expected to produce important savings (-31%) if used after failure of one or more TNFa therapies. This is mainly due to its lower drug acquisition cost. These savings could increase with the development of rituximab in earlier stages of treatment. (C) 2008 Elsevier Masson SAS. All rights reserved.