| Summary: | Tocilizumab (Actemra, TCZ) is an IL-6 receptor agonist indicated for the treatment of giant cell arteritis (GCA) in adult patients. The recommended dose is 162 mg administered via subcutaneous injection weekly for two years plus 26 weeks of prednisone tapering. It is supplied as a solution for injection in a 0.9 mL syringe. The submitted price of TCZ is $358.90 per syringe injection. The manufacturer submitted a cost-utility analysis comparing TCZ plus prednisone with prednisone alone in adult patients with GCA over a lifetime time horizon of 20 years from the perspective of the Canadian health care payer. A semi-Markov model was developed based on the GiACTA trial data4 and extrapolated to a second year (on TCZ treatment) and beyond. The model considered flare after treatment, as well as GCA- or prednisone-related adverse events (AEs). The treatment effects and safety of TCZ plus prednisone and prednisone alone were taken from the GiACTA trial. Other inputs such as costs and utility values were obtained from published literature. In its base case, the manufacturer reported that an incremental cost of $32,612 and incremental quality-adjusted life-years (QALYs) of 0.42, resulting in an incremental costutility ratio (ICUR) of $85,496 per QALY when comparing TCZ plus prednisone with prednisone alone (probabilistic analysis)
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