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Cost-Effectiveness Analysis of Tocilizumab and Metotrexate for the treatment of Rheumatoid Arthritis: Markov Model Based on Data from a Balkan Country in socio-economic Transition Background/aim: Rheumatoid arthritis is chronic disease, associated with systematic inflammation and irreversible joint destruction. There are two main strategies in treatment of rheumatoid arthritis: to preclude the spreading of inflammation and to protect affected joints from further deterioration. Recent studies have shown that using of biological agents, especially tocilizumab, have clear efficacy on the course of rheumatoid arthritis. In spite of that, there are no published data about pharmacoeconomic side of using this biological drug in treatment for rheumatoid arthritis. The aim of our study was to compare cost- effectiveness of two therapeutic strategies in patient with rheumatoid arthritis: treatment with metotrexate alone or in combination with tocilizumab in the economic environment in Balkan region with recent history of socio-economic transition. Method: The Markov model was developed in order to compare cost effectiveness of combination of tocilizumab and metotrexate with metotrexate alone. The Markov model was based on the literature about effectiveness, and economic side of rheumatoid arthritis is estimated from medical documentation of actual patients treated in Clinical Centre of Kragujevac. The course of rheumatoid arthritis was presented trough five states using Health Assessment Questionnaire (HAQ). The time horizon was 480 months (40 years), and duration of one cycle is one month. The social perspective was used for costs and outcomes, as well as discount rate of 3%. Two-side sensitivity analysis was performed and its result was presented as Tornado diagram. Results: Results of our study indicate that treatment with metotrexate and tocilizumab comparing with metotrexate alone is not cost effective. The total costs for one year treatment per patient with metotrexate were on average 261945,42 RSD, or 2497,70 Euro and total costs for tretment with tocilizumab and metotrexate were on average 1959217,44 RSD, or 18659,20 Euro. Gain in QALYs is lower with tocilizumab and metotrexate than with metotrexate alone. Conclusion: In order to start including these drugs in health system of countries in socio-economic transition, prices of these drugs should be calculated on the basis of local pharmacoeconomic studies. Further research is necessary, especially to indentify subset of patient with rheumatoid arthritis in which tocilizumab will be cost effective therapy. Key words: rheumatoid arthritis, modeling in pharmacoeconomy, tocilizumab, cost/effectiveness. Literature:
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