Treatment Comparators

The treatment comparators in the model included bDMARDs and the tsDMARD, tofacitinib. In addition, while the population was patients with inadequate response or intolerance to csDMARDs, csDMARDs were also included to compare results with previously published US cost-effectiveness analyses. All comparators are licensed in the US for the treatment of RA and reimbursed through commercial health plan pharmacy budgets. Only SC formulations of bDMARDs were considered for comparison; IV formulations were not considered given that this formulation is typically reimbursed via medical benefits of commercial health plans.

The treatment sequence beginning with sarilumab 200 mg SC q2w + methotrexate was compared with treatment sequences beginning with:

adalimumab 40 mg SC q2w + methotrexate,

certolizumab 200 mg SC q2w + methotrexate,

etanercept 25 mg SC every week (q1w) + methotrexate,

golimumab 50 mg SC every 4 weeks (q4w) + methotrexate,

tocilizumab 162 mg SC q1w or q2w + methotrexate,

tofacitinib 5 mg twice daily (bid) oral + methotrexate,

csDMARD active treatment.

Efficacy and costs of the tocilizumab SC treatment regimen assumed in the model were based on a 65% q1w and 35% q2w weighted average of the two available dosing regimens. This was consistent with clinical guidance on usage and on results of claims databases analyses.