Indirect cost-effectiveness analyses of abatacept and rituximab in patients with moderate-to-severe rheumatoid arthritis in the United States

J Med Econ. 2010 Mar;13(1):33-41. doi: 10.3111/13696990903508021.


Objective: To estimate the incremental cost per quality-adjusted life-years (QALYs) for abatacept and rituximab, in combination with methotrexate, relative to methotrexate alone in patients with active rheumatoid arthritis (RA).

Methods: A patient-level simulation model was used to depict the progression of functional disability over the lifetimes of women aged 55-64 years with active RA and inadequate response to a tumor necrosis factor (TNF)-alpha antagonist therapy. Future health-state utilities and medical care costs were based on projected values of the Health Assessment Questionnaire Disability Index (HAQ-DI). Patients were assumed to receive abatacept or rituximab in combination with methotrexate until death or therapy discontinuation due to lack of efficacy or adverse events. HAQ-DI improvement at month 6, after adjustments for control drug (methotrexate) response, was derived from two clinical trials. Costs of medical care and biologic drugs, discounted at 3% annually, were from the perspective of a US third-party payer and expressed in 2007 US dollars.

Results: Relative to methotrexate alone, abatacept/methotrexate and rituximab/methotrexate therapies were estimated to yield an average of 1.25 and 1.10 additional QALYs per patient, at mean incremental costs of $58,989 and $60,380, respectively. The incremental cost-utility ratio relative to methotrexate was $47,191 (95% CI $44,810-49,920) per QALY gained for abatacept/methotrexate and $54,891 (95% CI $52,274-58,073) per QALY gained for rituximab/methotrexate. At an acceptability threshold of $50,000 per QALY, the probability of cost effectiveness was 90% for abatacept and 0.0% for rituximab.

Conclusion: Abatacept was estimated to be more cost effective than rituximab for use in RA from a US third-party payer perspective. However, head-to-head clinical trials and long-term observational data are needed to confirm these findings.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abatacept
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Antibodies, Monoclonal, Murine-Derived / economics*
  • Antibodies, Monoclonal, Murine-Derived / therapeutic use
  • Antirheumatic Agents / economics*
  • Antirheumatic Agents / therapeutic use
  • Cost-Benefit Analysis
  • Disability Evaluation
  • Female
  • Health Status Indicators
  • Humans
  • Immunoconjugates / economics*
  • Immunoconjugates / therapeutic use
  • Immunologic Factors / economics*
  • Immunologic Factors / therapeutic use
  • Methotrexate / economics*
  • Methotrexate / therapeutic use
  • Middle Aged
  • Monte Carlo Method
  • Quality-Adjusted Life Years
  • Rheumatic Fever / drug therapy
  • Rheumatic Fever / economics*
  • Rheumatic Fever / pathology
  • Rituximab
  • Severity of Illness Index
  • Surveys and Questionnaires
  • Tumor Necrosis Factor-alpha / antagonists & inhibitors
  • United States
  • Young Adult


  • Antibodies, Monoclonal, Murine-Derived
  • Antirheumatic Agents
  • Immunoconjugates
  • Immunologic Factors
  • Tumor Necrosis Factor-alpha
  • Rituximab
  • Abatacept
  • Methotrexate