Skip to main content

Cost-Effectiveness of Biosimilars vs Leflunomide

An economic evaluation of 25 099 rheumatoid arthritis patients found that treatment with biosimilar disease-modifying antirheumatic drugs (DMARDs) were cost-effective compared with the conventional DMARD, leflunomide. Does this suggest RA treatment guidelines need to be amended to allow biosimilars use immediately after the failure of methotrexate?

A cost-effectiveness analysis was performed using Hong Kong public electronic medical record data and a Markov disease transition model to simulate the lifetime disease progression and cost for patients with RA, using monetary valuesf rom 2022. The model assessed 3 competing treatment sequences initiated with biosimilar infliximab (CT-P13), biosimilar adalimumab (ABP-501), and leflunomide; all used in combination with methotrexate. The primary outcome was health care cost and quality-adjusted life-years (QALYs) of the simulated cohort.

From a total of 25 099 RA patients (mean age 56 years, 73% women), the lifetime health care cost and QALYs per treatment sequence initiated with:

  • Leflunomide - US $154 632 and 14.82 QALYs
  • Biosimilar infliximab (CT-P13) - US $152 326 and 15.35 QALYs
  • Biosimilar adalimumab (aBP-501) - US $145 419 and 15.55 QALYs

Both biosimilar choices presented lower costs and greater QALYs than the leflunomide choice. The incremental cost-effectiveness ratio (US$/QALY) comparing biosimilar infliximab sequence vs leflunomide sequence and biosimilar adalimumab sequence vs leflunomide sequence ranged from −15 797 to −8615 and −9088 to 10 238, respectively (all below the predefined willingness-to-pay threshold of US $48 555/QALY gain). 

Treatment initiated with biosimilar DMARDs were cost-effective compared with leflunomide in managing RA patients not responding to an initial methotrexate treatment. Cost-effective biosimilars need not be reserved for late stage, 3rd or 4th line treatment in RA.  


If you are a health practitioner, you may to comment.

Due to the nature of these comment forums, only health practitioners are allowed to comment at this time.

The author has no conflicts of interest to disclose related to this subject