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Rheumatology Advance Access originally published online on July 20, 2009
Rheumatology 2009 48(10):1236-1241; doi:10.1093/rheumatology/kep198
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Medico-economic evaluation of infliximab in rheumatoid arthritis—prospective French study of a cohort of 635 patients monitored for two years

Jacques Sany1,*, Jean-David Cohen1,*, Christophe Combescure2,3, Marie-Cécile Bozonnat4, Françoise Roch-Bras1, Georges Lafon5 and Jean-Pierre Daurès4

1Service d'Immuno-Rhumatologie, CHU Lapeyronie, Montpellier, 2Département de Biostatistiques et de Recherche Clinique, CHU Caremeau, Nîmes, France, 3Division of Clinical Epidemiology, University of Geneva, Geneva, Switzerland, 4Institut Universitaire de Recherche Clinique, Montpellier and 5George lafon Conseil, Paris, France.

Correspondence to: Jean-David Cohen, CHU Lapeyronie, Service d’Immuno-Rhumatologie, 191, avenue du Doyen Gaston Giraud, 34093 Montpellier cedex 5, France. E-mail: jd-cohen{at}chu-montpellier.fr


  Abstract

Objectives. To perform, in real conditions of prescription, the medico-economic evaluation of infliximab in severe RA.

Methods. A cost–effectiveness analysis of the annual costs was done with a comparison between the previous and the following year under infliximab. The effectiveness, determined from the HAQ, was expressed in clinically significant units and in quality-adjusted life years (QALYs). The incremental net benefit (INB), defined as willingness to pay ({lambda}), was used to express the results.

Results. A cohort of 635 patients was formed. Before the use of infliximab, after 1 and 2 years, the mean annual cost per patient for the care of RA was {euro}9832, 27 723 and 46 704, respectively. Among the direct costs, infliximab accounts for {euro}21 182 for the first year. The distribution of the different costs was similar after 2 years. By using the INB, the difference before and after 1 year under infliximab is significant, on average by 1.86 (S.E.M. = 0.76) when the effectiveness is expressed in clinically significant units. For severe HAQ, {lambda} is {euro}9841 (18 593 for all HAQ). When it is expressed in QALYs, also for severe HAQ, {lambda} >{euro}100 000. This can be explained by a short follow-up although severe complication of RA appears later.

Conclusion. An evaluation of the more long-term costs is required in order to determine whether there are any full economic benefits with this treatment.

KEY WORDS: Rheumatoid arthritis, Medico-economic, Infliximab, French cohort

*Jacques Sany and Jean-David Cohen equally contributed to this work.

Submitted 8 December 2008; revised version accepted 9 June 2009.
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