Rheumatology Advance Access originally published online on June 11, 2007
Rheumatology 2007 46(8):1345-1354; doi:10.1093/rheumatology/kem115
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Modelling the cost effectiveness of TNF-
antagonists in the management of rheumatoid arthritis: results from the British Society for Rheumatology Biologics Registry
1Health Economics and Decision Science, School of Health and Related Research (ScHARR), The University of Sheffield, UK, 2Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada, 3MRC Biostatistics Unit, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR and 4Arthritis Research Campaign Epidemiology Unit, The University of Manchester Medical School, Manchester M13 9PT, UK.
Correspondence to: Alan Brennan, Director of Health Economics and Decision Science, School of Health and Related Research (ScHARR), The University of Sheffield, UK. E-mail: a.brennan{at}sheffield.ac.uk
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Abstract |
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Objective. To evaluate the cost effectiveness of TNF-
antagonist therapies for rheumatoid arthritis (RA) in the United Kingdom using data from the British Society for Rheumatology Biologics Registry (BSRBR).
Methods. A simulation model is constructed to quantify the cost effectiveness of the TNF- antagonist therapies (infliximab, etanercept and adalimumab) as a group versus traditional disease-modifying anti-rheumatic drugs, with a time horizon over the full patient lifetime. Participants are UK NHS patients in the BSRBR with RA who have failed at least two traditional disease-modifying anti-rheumatic drugs. The BSRBR aims to recruit all RA patients starting on a TNF- antagonist agent and follows them 6 monthly via consultant and patient administered questionnaires. Data collected include disease activity scores (DAS28), the Health Assessment Questionnaire and the SF-36. Costs include drug, monitoring and hospitalisations. Benefits are measured in disability and quality of life improvements. The main outcome measure is the incremental cost per quality adjusted life-year gained (discounted).
Results. The basecase cost per quality adjusted life-year gained by using TNF- antagonist therapies is estimated at £23 882, with probabilistic uncertainty analysis suggesting that the probability that treatments are below £30 000 per QALY is around 84%. The results are most sensitive to assumptions concerning long-term disability progression, discount rates and the validity or otherwise of SF6D derived utility measures. Subgroup analysis, monotherapy versus combination with methotrexate, and a limited analysis of sequential therapy with two TNF- antagonist agents, suggest cost-effectiveness ratios around £20 000 to £30 000.
Conclusions. The BSRBR data provide valuable evidence for estimating cost-effectiveness. The analysis concludes that current policies and practice for the use of TNF- antagonist therapies, after RA patients have failed at least two traditional disease-modifying anti-rheumatic drugs, appear cost-effective in the context of the NICE re-appraisal of 2006 for England and Wales, thus supporting their decision to continue their reimbursement. Decision-makers worldwide might adapt this analysis because differential costs, discount rates and other factors could affect results. There remains uncertainty, particularly on long-term disease progression. Further data collection using the BSRBR is recommended, together with a revision to this analysis when data become available.
KEY WORDS: Anti-TNF, cost, cost-effectiveness, rheumatoid arthritis
Submitted 18 September 2006;
revised version accepted 26 March 2007.
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