Cost-effectiveness Analysis of Rituximab and Cyclophosphamide/Azathioprine in the Treatment of Antineutrophil Cytoplasmic Antibody-associated Vasculitis

OBJECTIVE  To evaluate the economics of rituximab(RTX) versus cyclophosphamide(CYC)/azathioprine(AZA) for the treatment of antineutrophil cytoplasmic antibody(ANCA)-associated vasculitis(AAV) from the Chinese healthcare system.

METHODS Based on the results of two randomised controlled trials(RCT), a Markov model was developed for cost-effectiveness analysis, with a cycle of 6 months, a simulation timeframe of patients’ lifetime, and a discount rate of 5%. The incremental cost-effectiveness ratio(ICER) was used as an indicator to evaluate the economics, and the results were analyzed for sensitivity.

RESULTS The results of the cost-effectiveness analysis showed that the ICER of RTX versus CYC/AZA was USD/quality-adjusted life year, which was lower than 3 times the per capita gross domestic product(GDP) of China in 2022. The results of the one-factor sensitivity analysis showed that the most influential factors on the ICER were the price of RTX, discount rate, and utility value of the disease activity status; and the probabilistic sensitivity analysis showed that RTX was cost-effectiveness compared to CYC/AZA, when the willingness-to-pay threshold was set at 3 times the GDP, the RTX had a cost-effectiveness for CYC/AZA.

Conclusion In induction and maintenance treatment of AAV, compared with CYC/AZA, RTX is more cost-effectiveness.