A 46-year-old woman comes to the office due to persistent joint pains. She has a history of rheumatoid arthritis and, for the past 6 months, has been on methotrexate (Mtx) therapy. However, her symptoms have shown little improvement. She has morning stiffness that lasts for 1 hour, and her erythrocyte sedimentation rate is 40 mm/hr. A discussion is initiated regarding modifying her therapy to include either subcutaneous (SC) tocilizumab (TCZ_SC) or SC abatacept (ABT_SC) in addition to Mtx. The patient expressed wanting to attempt the most effective treatment and avoid having to modify her treatment again. The mean cost of treatment per number needed to treat (NNT), obtained by multiplying the yearly individual cost by the NNT, is considered an indicator of the clinical benefits and costs linked to the use of the therapies. Based on the results of the meta-analysis, which of the following best describes the clinical benefits and costs of rheumatoid arthritis therapies per NNT in patients previously treated with Mtx?

Question

A 46-year-old woman comes to the office due to persistent joint pains. She has a history of rheumatoid arthritis and, for the past 6 months, has been on methotrexate (Mtx) therapy. However, her symptoms have shown little improvement. She has morning stiffness that lasts for >1 hour, and her erythrocyte sedimentation rate is 40 mm/hr. A discussion is initiated regarding modifying her therapy to include either subcutaneous (SC) tocilizumab (TCZ_SC) or SC abatacept (ABT_SC) in addition to Mtx. The patient expressed wanting to attempt the most effective treatment and avoid having to modify her treatment again. The mean cost of treatment per number needed to treat (NNT), obtained by multiplying the yearly individual cost by the NNT, is considered an indicator of the clinical benefits and costs linked to the use of the therapies. Based on the results of the meta-analysis, which of the following best describes the clinical benefits and costs of rheumatoid arthritis therapies per NNT in patients previously treated with Mtx?

Quizplus · Accepted Answer

Explanation: In this example, approximately 10 patients would have to be treated with (ABT_sc + Mtx) to prevent 1 additional patient not achieving ≥70% improvement, whereas only 4 patients would have to be treated with (TCZ _sc + Mtx) to achieve the same outcome. _sc _sc Based on the results of the article, the mean cost of treatment per NNT for each treatment would be: Mean cost per NNT for (ABT_sc + Mtx) = 10 patients × $6,300/patient = $63,000 (Choice B) _sc Mean cost per NNT for (TCZ_sc + Mtx) = 4 patients × $6,800/patient = $27,200 (Choices A and C) _sc Consequently, compared to Mtx, (TCZ_sc + Mtx) represents a more cost-effective therapy per NNT than (ABT_sc + Mtx) (Choice E). _sc _sc Educational objective: The mean cost per number needed to treat (NNT) represents a measure of cost-effectiveness of therapies. The lower the mean cost per NNT, the more cost-effective the therapy. The mean cost per NNT may be used to compare cost-effectiveness between available treatments.

A 46-Year-Old Woman Comes to the Office Due to Persistent