TOCILIZUMAB IN COMBINATION WITH CORTICOSTEROIDS FOR THE TREATMENT OF GIANT CELL ARTERITIS: A BUDGET IMPACT ANALYSIS IN ITALY

Objectives: To estimate the economic impact of tocilizumab (TCZ) administered weekly in combination with a 26-week prednisone taper regimen, for the treatment of giant cell arteritis (GCA), in the Italian market. Methods: A deterministic semi-Markov model was developed to simulate the evolution of GCA patients in Italy for 3 years. Baseline characteristics, transition probabilities and event rates were modelled according to the results of the phase III trial GiACTA. A comprehensive third-party payer perspective encompassing only direct health costs (drugs, resources consumption, and adverse events management) was adopted to evaluate the switch of all patients, currently treated with prednisone alone, to the new combination regimen of TCZ + prednisone. Target patients were estimated for 2019-2021 starting from Italian population (>50 years) applying national epidemiologic data and considering only patients eligible to receive TCZ. Results: In the next three years 1,314 patients are expected to be treated: 161 in the first, 492 in the second and 661 in the third year of analysis. The switch to TCZ combination therapy results in an increase in the total cost of less than 15 million Euro for 3 years corresponding to 11,250 Euro/patient yearly. If the therapy adherence is included, the economic impact reduces to less than 12 million Euro for 3 years, corresponding to 8,775 Euro/patient yearly. Conclusions: Treatment cost of GCA depends almost completely on pharmacological therapy. Changes in the current prescription scenario, with the adoption of TCZ, have a sustainable economic impact; in particular, considering a realistic adherence.