Abstract
Objective and Introduction: A wide variety of treatment options have become available for rheumatoid arthritis. Biosimilars are highly effective in treating rheumatoid arthritis but are rarely considered as first line therapy because of their high cost. This study evaluates cost effectiveness and affordability of various biosimilars available in market for rheumatoid arthritis.
Methodology: Three biosimilarsAdalimumab, Infliximab and Etanercept were compared in this study. Weighted average of proportion of patients achieving ACR (American College of Rheumatology)20, ACR 50 and ACR 70 were considered as measure of outcome from published clinical trials. The data related to the cost of the drugs has been collected from authenticated sources and cost effectiveness was calculated. Affordability is analysed comparing the price of drug and daily wage of an unskilled labour. The data related to daily wage of unskilled labour has been collected from the authenticated sources.
Results: In this analysis we found that Etanercept was cost effective, it costs 2,42,000 for 78.6% patients achieving ACR 20, 50.5% patients achieving ACR 50 and 25.5% patients achieving ACR 70. The next least expensive option is Infliximab costing 2,97,000 for 76.1% patients achieving ACR 20, 57.63% patients achieving ACR 50 and 29% patients achieving ACR 70. Adalimumab is the expensive option costing 6,00,00 which is least effective when compared with the two options. It takes 691 days for an unskilled daily wager to afford etanercept to achieve above mentioned outcome. It takes 849 days wage of an unskilled daily wager to afford infliximab to achieve above mentioned outcome. It takes 1714 days wage of an unskilled daily wager to afford adalimumab to achieve above mentioned outcome.
Conclusion: Our analysis indicates that Etanercept 25mg twice weekly is cost effective for achieving ACR20, ACR 50 and ACR 70 over a period of 22 weeks. Even though all these drugs are highly effective in the treatment of rheumatoid arthritis they are beyond the affordability of common man. The government of India should take effective measures to bring these drugs under DPCO regulation.