Rheumatology Advance Access originally published online on August 2, 2008
Rheumatology 2008 47(10):1590; doi:10.1093/rheumatology/ken326
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Comment on: Infliximab, etanercept and adalimumab for the treatment of ankylosing spondylitis: cost-effectiveness evidence and NICE guidance: reply
1Health Economics and Decision Science, ScHARR, University of Sheffield, Sheffield, UK and 2Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada
Correspondence to: A. Wailoo, Health Economics and Decision Science, ScHARR, University of Sheffield, Sheffield, UK. E-mail: a.j.wailoo{at}sheffield.ac.uk
SIR, In our editorial [1], we outlined the considerations National Institute for Health and Clinical Excellence (NICE) has had to make when considering extremely different estimates of cost effectiveness made by sponsors of the three TNF antagonists and an independent assessment group. Kobelt, an author of one of the sponsored studies questions the factual basis of the editorial and integrity of the authors [2].
First, Kobelt [2] correctly states that the £19 196 per quality adjusted life year (QALY) figure we quote does not appear in her publication but this has no effect on the issues raised in the editorial. The £19 196 per QALY was the original figure submitted to NICE by Schering Plough (SP) [3] (for the ASSERT trial) and Kobelt accepts that this was based on a model that contained a significant error, uncovered by the NICE process. A revised figure of £26 751 was resubmitted to NICE [4] (for the ASSERT trial) and also appears in the published article [5]. When the independent assessment group replicated the SP model and corrected this error they obtained a figure of £41K per QALY (ASSERT trial) [6]. We used the actual model and software supplied by Schering Plough and obtained a figure of £42K per QALY [7] when the error was corrected. The point of our editorial therefore remains—two independent assessments identified an error in the model, corrected it and obtained similar results that substantially exceed the £30 000 per QALY that serves as an upper bound on what is typically considered cost-effective.
Second, Kobelt [2] attempts to distinguish the analysis submitted to NICE from the publication and questions our right to publish our findings. In fact, both refer to the same analysis and the distinction is therefore entirely artificial. No confidential information is cited in our report and full details of all the analyses we undertook are in the public domain on the NICE website (http://www.nice.org.uk). Our motivation was to provide a summary, accessible to the rheumatological community who are unlikely to wade through the hundreds of pages of documentation underlying this appraisal. We contend that transparency should be encouraged not restricted.
Lastly, we would like to confirm that the authors of this editorial have complied with journal policy in declaring conflicts of interest. The unit in which this work was undertaken, the Decision Support Unit, is wholly funded by NICE, abides by and exceeds the Institute's strict code of practice [8].
Disclosure statement: The authors have declared no conflicts of interest.
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- Wailoo A, Bansback N, Chilcott J. Infliximab, etanercept and adalimumab for the treatment of ankylosing spondylitis: cost-effectiveness evidence and NICE guidance. Rheumatology (2008) 47:119–20.
[Free Full Text] - Kobelt G. Comment on: Infliximab, etanercept and adalimumab for the treatment of ankylosing spondylitis: cost-effectiveness evidence and NICE guidance. Rheumatology (2008) 47:1589–90.
[Free Full Text] - Schering Plough Limited. Remicade® in the treatment of ankylosing spondylitis in England and Wales. In: A Submission to the National Institute for Health and Clinical Excellence (2006) (28 April 2008, date last accessed). http://www.nice.org.uk/nicemedia/pdf/AnkySpondMSSP.pdf.
- Schering Plough Limited. Letter responding to assessment report, dated 10th July 2006. (28 April 2008, date last accessed). http://www.nice.org.uk/nicemedia/pdf/AnkySpondCCSP.pdf.
- Kobelt G, Sobocki P, Sieper J, Braun J. Comparison of the cost effectiveness of infliximab in the treatment of ankylosing spondylitis in the United Kingdom based on two different clinical trials. Int J Technol Assess Health Care (2007) 23:368–75.[CrossRef][Web of Science][Medline]
- McLeod C, Bagust A, Boland A, et al. Adalimumab, etanercept, and infliximab for the treatment of ankylosing spondylitis: a systematic review & economic evaluation. Health Technol Assess. (28 April 2008, date last accessed). http://www.nice.org.uk/nicemedia/pdf/AnkySpondAssessmentReport.pdf (in press).
- Bansback N, Wailoo A. Comparisons of submitted models for the appraisal of etanercept, adalimumab and infliximab for ankylosing spondylitis. In: Report by the Nice Decision Support Unit. 2007. http://guidance.nice.org.uk/page.aspx?o=441923 (28 April 2008, date last accessed).
- NICE. A code of practise for declaring and dealing with conflicts of interest. (2006) (28 April 2008, date last accessed). http://guidance.nice.org.uk/page.aspx?o=441923.
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