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Cost-effectiveness of etanercept treatment in early active rheumatoid arthritis followed by dose adjustment.

Kobelt, Gisela LU ; Lekander, Ingrid ; Lang, Andrea ; Raffeiner, Bernd ; Botsios, Costantino and Geborek, Pierre LU (2011) In International Journal of Technology Assessment in Health Care 27(3). p.193-200
Abstract
Objectives: To explore the cost-effectiveness of early biologic treatment, followed by dose-reduction in the case of remission, of active rheumatoid arthritis (RA), compared with standard treatment with methotrexate (MTX) in Sweden.Methods: Effectiveness (function, disease activity, erosions) in early RA for both alternatives was taken from a clinical trial comparing etanercept (ETA) combined with MTX to MTX alone. Patients discontinuing treatment can switch to another or their first biologic treatment. For patients in remission (Disease Activity Score [DAS28] < 2.6), ETA is reduced to half the dose. Return to full dose occurs when DAS28 reaches ≥ 3.2 again. Costs and utilities by level of functional capacity from an observational study... (More)
Objectives: To explore the cost-effectiveness of early biologic treatment, followed by dose-reduction in the case of remission, of active rheumatoid arthritis (RA), compared with standard treatment with methotrexate (MTX) in Sweden.Methods: Effectiveness (function, disease activity, erosions) in early RA for both alternatives was taken from a clinical trial comparing etanercept (ETA) combined with MTX to MTX alone. Patients discontinuing treatment can switch to another or their first biologic treatment. For patients in remission (Disease Activity Score [DAS28] < 2.6), ETA is reduced to half the dose. Return to full dose occurs when DAS28 reaches ≥ 3.2 again. Costs and utilities by level of functional capacity from an observational study are used. The model is analyzed as a micro-simulation and results are presented from the societal perspective for Sweden, for 10 years; costs (€2008) and effects are discounted at 3 percent. Sensitivity analysis was performed for the perspective, the time horizon, switching, and dose-reduction.Results: The main analysis conservatively assumes 50 percent switching at discontinuation. The cost per quality-adjusted life-year (QALY) gained with early ETA/MTX treatment is €13,500 (societal perspective, incremental cost of €15,500 and incremental QALYs of 1.15). With 75 percent switching, the cost per QALY gained was €10,400. Over 20 years, the cost per QALY gained was €8,200. Results were further sensitive to the time patients remained on half dose and the perspective.Conclusions and Policy Implications: This study combines clinical trial and clinical practice data to explore cost-effective treatment scenarios in early RA, including the use of biologics. Our results indicate that a situation where a considerable proportion of patients achieve remission, dose-adjustments will increase the cost-effectiveness of treatment. (Less)
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author
; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
International Journal of Technology Assessment in Health Care
volume
27
issue
3
pages
193 - 200
publisher
Cambridge University Press
external identifiers
  • wos:000293130000002
  • pmid:21736857
  • pmid:21736857
  • scopus:80155157726
ISSN
1471-6348
DOI
10.1017/S0266462311000195
language
English
LU publication?
yes
id
0426cb0a-17e4-4d59-afc2-c904abefab00 (old id 2058868)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/21736857?dopt=Abstract
date added to LUP
2016-04-04 08:33:21
date last changed
2022-04-08 00:07:03
@article{0426cb0a-17e4-4d59-afc2-c904abefab00,
  abstract     = {{Objectives: To explore the cost-effectiveness of early biologic treatment, followed by dose-reduction in the case of remission, of active rheumatoid arthritis (RA), compared with standard treatment with methotrexate (MTX) in Sweden.Methods: Effectiveness (function, disease activity, erosions) in early RA for both alternatives was taken from a clinical trial comparing etanercept (ETA) combined with MTX to MTX alone. Patients discontinuing treatment can switch to another or their first biologic treatment. For patients in remission (Disease Activity Score [DAS28] &lt; 2.6), ETA is reduced to half the dose. Return to full dose occurs when DAS28 reaches ≥ 3.2 again. Costs and utilities by level of functional capacity from an observational study are used. The model is analyzed as a micro-simulation and results are presented from the societal perspective for Sweden, for 10 years; costs (€2008) and effects are discounted at 3 percent. Sensitivity analysis was performed for the perspective, the time horizon, switching, and dose-reduction.Results: The main analysis conservatively assumes 50 percent switching at discontinuation. The cost per quality-adjusted life-year (QALY) gained with early ETA/MTX treatment is €13,500 (societal perspective, incremental cost of €15,500 and incremental QALYs of 1.15). With 75 percent switching, the cost per QALY gained was €10,400. Over 20 years, the cost per QALY gained was €8,200. Results were further sensitive to the time patients remained on half dose and the perspective.Conclusions and Policy Implications: This study combines clinical trial and clinical practice data to explore cost-effective treatment scenarios in early RA, including the use of biologics. Our results indicate that a situation where a considerable proportion of patients achieve remission, dose-adjustments will increase the cost-effectiveness of treatment.}},
  author       = {{Kobelt, Gisela and Lekander, Ingrid and Lang, Andrea and Raffeiner, Bernd and Botsios, Costantino and Geborek, Pierre}},
  issn         = {{1471-6348}},
  language     = {{eng}},
  number       = {{3}},
  pages        = {{193--200}},
  publisher    = {{Cambridge University Press}},
  series       = {{International Journal of Technology Assessment in Health Care}},
  title        = {{Cost-effectiveness of etanercept treatment in early active rheumatoid arthritis followed by dose adjustment.}},
  url          = {{http://dx.doi.org/10.1017/S0266462311000195}},
  doi          = {{10.1017/S0266462311000195}},
  volume       = {{27}},
  year         = {{2011}},
}