The clinical effectiveness and cost-effectiveness of abatacept, adalimumab, etanercept and tocilizumab for treating juvenile idiopathic arthritis: a systematic review and economic evaluation

This review of 4 RCTs found that the 4 biologics are superior to placebo in children with juvenile idiopathic arthritis who have had insufficient response to prior therapy. Randomised comparisons are required to effectively establish their comparative efficacy

An indirect comparison suggests that the four biologic DMARDs are similar, but that confidence intervals were wide, the number of trials was low and there was clinical heterogeneity between trials.  The incremental cost-effectiveness ratios (ICERs) for adalimumab, etanercept and tocilizumab versus methotrexate were £38,127, £32,526 and £38,656 per quality-adjusted life year (QALY), respectively. The ICER for abatacept versus methotrexate as a second-line biologic was £39,536 per QALY. The authors highlight that randomised comparisons of biologic DMARDs with long-term efficacy and safety follow-up are needed to establish comparative effectiveness.

 

NICE TA373 recommends abatacept, adalimumab, etanercept and tocilizumab, within specific criteria, for the treatment of juvenile idiopathic arthritis