Rheumatology Advance Access published online on June 2, 2007
Rheumatology, doi:10.1093/rheumatology/kem031
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Cost effectiveness of adalimumab for the treatment of ankylosing spondylitis in the United Kingdom
Pharmerit North America LLC, Bethesda, MD, 1University of Southern California, Los Angeles, CA, 2Abbott Laboratories, Abbott Park, IL, USA, 3Abbott Laboratories, Berks, UK, 4Abbott Laboratories, Parsippany, NJ, USA and 5University Medical Centre Utrecht, Utrecht, The Netherlands
Correspondence to:
Marc Botteman. E-mail: mbotteman{at}pharmerit.com
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Abstract |
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Objectives. This study evaluated the cost effectiveness of adalimumab vs conventional therapy in patients with active ankylosing spondylitis (AS).
Methods. The analysis was based on pooled data from two Phase III studies of adalimumab in active AS. Patients with an inadequate response to 
1 NSAID received adalimumab 40 mg every other week (n = 246) or placebo (n = 151) for 24 weeks. A microsimulation model was developed with patients being treated with adalimumab according to the International ASAS Consensus Statement and BSR guidelines. The pooled adalimumab data, as well as data from the Outcome Assessment in AS International Study (OASIS) database and the literature, were used to model patients’ BASDAI and BASFI scores and costs and health-related quality of life associated with various degrees of disease activity. Costs (in 2004 British £) of AS, drug, administration, monitoring, hospitalization and AEs were calculated from the perspective of the UK NHS. Discounting was applied at 3.5% per year for costs and benefits as per the NICE reference case for economic evaluations. Uncertainty was addressed via sensitivity analyses.
Results. The incremental cost-effectiveness ratio (ICER) of adalimumab vs conventional therapy was estimated to improve with longer time horizons (48 weeks to 5 and 30 yrs). The central estimate was that, over 30 yrs, adalimumab therapy yielded 1.03 more quality-adjusted life-years (QALYs) per patient initiating therapy. Some AS treatment-related costs were estimated to be offset by adalimumab (at £10 750/patient), leaving a total incremental cost (adalimumab vs conventional therapy) at £23 857 per patient. The 30-yr ICER of adalimumab vs conventional therapy was estimated at £23 097/QALY. Sensitivity analyses demonstrated robustness of results. When indirect costs were also included (analysis from societal perspective), ICER improved to £5093/QALY.
Conclusions. This analysis indicates that adalimumab, when used according to UK treatment guidelines, is cost-effective vs conventional therapy for treating AS patients.
KEY WORDS: Ankylosing spondylitis, Adalimumab, Tumour necrosis factor antagonists, Cost effectiveness, Quality-adjusted life-years, Incremental cost-effectiveness ratio, Pharmacoeconomics, United Kingdom treatment guidelines, Randomized controlled trials, Therapeutic biologics
Submitted 15 September 2006;
revised version accepted 16 January 2007.
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