Cost-effectiveness of vagus nerve-mediated neuroimmune modulation for the treatment of moderate-to-severe rheumatoid arthritis.

Abstract

Aims: Rheumatoid arthritis (RA) is associated with increased healthcare resource utilization and high-cost pharmacologic treatment. The objective of the current analysis was to evaluate the cost-effectiveness of vagus nerve-mediated neuroimmune modulation therapy (NIMT) using a novel implantable neurostimulation technology compared to status-quo pharmacologic treatment of moderate-to-severe rheumatoid arthritis patients in the US.

Materials and methods: A decision-analytic Markov model was utilized to project strategy-specific costs and outcomes over 2-, 10-year, and lifetime horizons for NIMT and the status-quo. Clinical data from the RESET-RA study informed key model inputs including cohort characteristics, utilities, event rates, and medication utilization. Costs were derived from published literature and current reimbursement rates. The analysis was conducted from the US payer perspective, with both costs and outcomes discounted 3% in accordance with US cost-effectiveness guidelines. Cost-effectiveness was evaluated using established US willingness-to-pay thresholds of $50,000 (highly cost-effective) and $150,000 (cost-effective) per quality-adjusted life year (QALY) gained. Deterministic and probabilistic sensitivity analyses (PSA) were performed.

Results: Under the base case assumptions, NIMT was cost-saving in less than 2 years. Over lifetime, NIMT was associated with incremental cost-savings of $350,052 and QALY gain of 0.87, and led to cost-savings of $25,397 and $197,062, and concurrent incremental QALY gains of 0.10 and 0.46 at 2 and 10 years, rendering NIMT the dominant strategy across all three horizons. In the PSA, NIMT was cost-effective at thresholds of $50,000 and $150,000 per QALY gained in 96.25% and 99.20% of simulations at 2 years, and 100% of simulations at 10 years and lifetime.

Conclusion: In this model-based analysis of a recent randomized trial, the use of NIMT therapy corresponded to a reduction in total costs of care, improved quality of life, and was found to be a highly cost-effective or dominant treatment option for moderate-to-severe rheumatoid arthritis in a US setting.