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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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organization
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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
external identifiers
  • wos:000293130000002
  • 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
2011-08-01 19:19:50
date last changed
2017-01-01 07:37:14
@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},
  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},
  volume       = {27},
  year         = {2011},
}