Background The use of rituximab as maintenance treatment of antineutrophil cytoplasm antibody-associated vasculitides (AAVs) was supported by the MAINRITSAN trial. MAINRITSAN2 was a randomised, open-label, multicentre phase III trial which evaluated the difference between an individually tailored and a fixed-schedule maintenance therapy with rituximab. We found a large number of studies evaluating rituximab as a maintenance treatment in AAVs, but only a few looked at economic considerations. This cost-minimisation analysis (CMA) provides the best data available to date on the cost-saving option between a tailored-therapy and a fixed-schedule regimen with rituximab for the maintenance treatment of AAVs.

Purpose The present study used a cost-minimisation approach to examine the real-world costs of an individually tailored therapy compared to a fixed-schedule therapy with rituximab for remission maintenance of AAVs.

Material and methods We performed a CMA over an 18 month time period, estimating direct costs – drug acquisition, preparation, administration and monitoring costs – from the National Health Service perspective. We conducted a number of additional sensitivity analyses with different assumptions for unit costs, with two further scenarios including the interquartile range of the tailored-infusion group. In this analysis, we established a point of view of the health system without considering patients’ preferences, or indirect and intangible costs.

Results The individually tailored maintenance therapy with rituximab was shown to be a cost-saving treatment compared to the fixed-schedule therapy (€6,048.36 vs. €7,850.52). Savings resulted primarily from lower drug acquisition costs (€2,861.01 vs. €4,768.35) and lower preparation and administration costs (€891.81vs. €1,486.35), due to the lower number of infusions per patient in the tailored-infusion regimen. In contrast, the tailored-infusion regimen presented higher costs in monitoring (€2,295.54 vs. €1,886.70). This result was replicated in all assumptions considered in the sensitivity analysis.

Conclusion From the perspective of the health system, the tailored-therapy regimen would seem to be the preferable option in terms of costs. Further studies assessing all the costs associated to AAVs maintenance treatment with rituximab are needed to support clinical management and healthcare planning.

References and/or acknowledgements The authors thank Eduardo López Briz, Ana Ortega Eslava and Oblikue Consulting, S.L for their participation.

No conflict of interest.