The cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice
(2013) In European Journal of Health Economics 14(6). p.863-873- Abstract
- The objective was to estimate the cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice, both as a first and second biological treatment, with or without the combination of conventional DMARDs. Further sub-group analysis of etanercept treatment was performed. Patient level data were obtained from three regions of the Swedish Rheumatology Registers. The dataset contained 2,558 patients who had started TNF-inhibitor treatment, 1,049 with etanercept as their first biological treatment. A total of 819 patients had switched to a second TNF-inhibitor, of which 425 to etanercept. A Markov cohort model was used in which health states of disease severity were classified according to HAQ and... (More)
- The objective was to estimate the cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice, both as a first and second biological treatment, with or without the combination of conventional DMARDs. Further sub-group analysis of etanercept treatment was performed. Patient level data were obtained from three regions of the Swedish Rheumatology Registers. The dataset contained 2,558 patients who had started TNF-inhibitor treatment, 1,049 with etanercept as their first biological treatment. A total of 819 patients had switched to a second TNF-inhibitor, of which 425 to etanercept. A Markov cohort model was used in which health states of disease severity were classified according to HAQ and DAS28. Disease progression and discontinuation rates of TNF-inhibitors were based on the registry and for the comparator on published literature. Mortality, costs and utilities were based on Swedish data. The main analysis had a societal perspective over 20 years and efficacy was measured in quality-adjusted life-years (QALYs). TNF-inhibitor treatment was associated with an increase in QALYs and an incremental cost compared to no biological treatment. The cost per QALY gained with the three TNF-inhibitors ranged from a,not sign50,000 to a,not sign120,000, with lower estimates for TNF-inhibitors used in combination with MTX and as a first biologic. At a progression of 0.045 for the comparator, most values remain within the accepted range for cost-effectiveness. These results demonstrate that the cost per QALY for TNF-inhibitors was higher than in previous assessments based on registry data and that the results were sensitive to the HAQ progression of the comparator. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/4212528
- author
- Lekander, Ingrid ; Borgstrom, Fredrik ; Lysholm, Jorgen ; van Vollenhoven, Ronald F. ; Lindblad, Staffan ; Geborek, Pierre LU and Kobelt, Gisela
- organization
- publishing date
- 2013
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Retrospective, Registry data, Disease progression, Etanercept, Cost-effectiveness analysis, Rheumatoid arthritis, Clinical practice, Sweden, Anti-TNF
- in
- European Journal of Health Economics
- volume
- 14
- issue
- 6
- pages
- 863 - 873
- publisher
- Springer
- external identifiers
-
- wos:000326111200003
- scopus:84888432068
- pmid:22990378
- ISSN
- 1618-7601
- DOI
- 10.1007/s10198-012-0431-6
- language
- English
- LU publication?
- yes
- id
- c43558da-0212-4ec6-a951-bbc0127f526c (old id 4212528)
- date added to LUP
- 2016-04-01 10:01:09
- date last changed
- 2022-04-12 01:09:23
@article{c43558da-0212-4ec6-a951-bbc0127f526c, abstract = {{The objective was to estimate the cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice, both as a first and second biological treatment, with or without the combination of conventional DMARDs. Further sub-group analysis of etanercept treatment was performed. Patient level data were obtained from three regions of the Swedish Rheumatology Registers. The dataset contained 2,558 patients who had started TNF-inhibitor treatment, 1,049 with etanercept as their first biological treatment. A total of 819 patients had switched to a second TNF-inhibitor, of which 425 to etanercept. A Markov cohort model was used in which health states of disease severity were classified according to HAQ and DAS28. Disease progression and discontinuation rates of TNF-inhibitors were based on the registry and for the comparator on published literature. Mortality, costs and utilities were based on Swedish data. The main analysis had a societal perspective over 20 years and efficacy was measured in quality-adjusted life-years (QALYs). TNF-inhibitor treatment was associated with an increase in QALYs and an incremental cost compared to no biological treatment. The cost per QALY gained with the three TNF-inhibitors ranged from a,not sign50,000 to a,not sign120,000, with lower estimates for TNF-inhibitors used in combination with MTX and as a first biologic. At a progression of 0.045 for the comparator, most values remain within the accepted range for cost-effectiveness. These results demonstrate that the cost per QALY for TNF-inhibitors was higher than in previous assessments based on registry data and that the results were sensitive to the HAQ progression of the comparator.}}, author = {{Lekander, Ingrid and Borgstrom, Fredrik and Lysholm, Jorgen and van Vollenhoven, Ronald F. and Lindblad, Staffan and Geborek, Pierre and Kobelt, Gisela}}, issn = {{1618-7601}}, keywords = {{Retrospective; Registry data; Disease progression; Etanercept; Cost-effectiveness analysis; Rheumatoid arthritis; Clinical practice; Sweden; Anti-TNF}}, language = {{eng}}, number = {{6}}, pages = {{863--873}}, publisher = {{Springer}}, series = {{European Journal of Health Economics}}, title = {{The cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice}}, url = {{http://dx.doi.org/10.1007/s10198-012-0431-6}}, doi = {{10.1007/s10198-012-0431-6}}, volume = {{14}}, year = {{2013}}, }