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Cost-minimisation analysis of subcutaneous methotrexate versus biologic therapy for the treatment of patients with rheumatoid arthritis who have had an insufficient response or intolerance to oral methotrexate

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Abstract

This study aims to model the economic impact of subcutaneous methotrexate (SC MTX) or a biologic over a 12-month period using a hypothetical population of rheumatoid arthritis patients who failed to tolerate or respond to oral MTX and were suitable candidates for biologic therapy. A decision-based model was developed using current National Institute for Health and Clinical Excellence (NICE) guidance to determine the management of this hypothetical UK population. Published data on the continuation rates of SC MTX and biologics were used to compare the costs of the two treatment options. The economic model used a cost-minimisation methodology from a UK National Health Service (NHS) perspective, with the cost of all drugs and resources being estimated on this basis. Sensitivity analyses were also performed to determine the effects of changing key assumptions on the mean cost differences. The routine use of SC MTX following oral MTX failure has the potential to save an estimated £7,197 per patient in the first year of therapy and £9.3m per year nationally in new patients. Sensitivity analyses support the robustness of the results. The results of this study suggest that routine use of SC MTX following oral MTX failure has the potential to provide considerable savings to the NHS through optimised use of MTX first-line therapy. It is proposed, therefore, that patients should start on oral MTX with a subsequent switch to SC MTX in the case of an insufficient response or tolerability issues, before introducing a biologic agent.

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Acknowledgments

We would like to thank Julie Blake, Strategen Ltd., for providing writing and editorial support and Strategen Ltd. for their assistance with the modelling. Strategen Ltd. received a fee in this regard from medac UK.

Funding

This study was supported by an unrestricted educational grant by medac UK.

Conflict of interest

R.F. and D.G.I.S. have received fees in the past for presenting at medac UK meetings and as advisors to the company. I.K. received a fee as an external consultant by medac UK.

Author information

Authors and Affiliations

  1. Royal Wolverhampton Hospitals, New Cross Hospital, Wolverhampton, UK

    Ray Fitzpatrick

  2. Norfolk and Norwich University Hospital, Colney Lane, Norwich, Norfolk, UK

    David GI Scott

  3. Strategen Ltd., Basingstoke, Hampshire, UK

    Ian Keary

Authors
  1. Ray Fitzpatrick
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  2. David GI Scott
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  3. Ian Keary
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Corresponding author

Correspondence to Ray Fitzpatrick.

Additional information

Key messages

• Guidelines recommend MTX as the first-line DMARD for patients with RA before biologic therapy

• SC MTX is effective in oral MTX failures, reducing the need for biologic therapy

• Routine SC MTX use produces financial NHS savings by reducing the need for biologic therapy.

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Fitzpatrick, R., Scott, D.G. & Keary, I. Cost-minimisation analysis of subcutaneous methotrexate versus biologic therapy for the treatment of patients with rheumatoid arthritis who have had an insufficient response or intolerance to oral methotrexate. Clin Rheumatol 32, 1605–1612 (2013). https://doi.org/10.1007/s10067-013-2318-z

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  • DOI: https://doi.org/10.1007/s10067-013-2318-z

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