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

1, 2, 3


  1. SIHS Health Economics Consulting, Torino, Italy.
  2. Rheumatology Unit, S.Giovanni di Dio Hospital, Florence, Italy.
  3. Department of Rheumatology, Gaetano Pini Institute, Milan, Italy.

2018 Vol.36, N°3
PI 0479, PF 0485
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PMID: 29352843 [PubMed]

Received: 02/07/2017
Accepted : 16/10/2017
In Press: 15/01/2018
Published: 17/05/2018


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.
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.
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.
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.

Rheumatology Article