Cost-effectiveness of etanercept treatment in early active rheumatoid arthritis followed by dose adjustment.
(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)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/2058868
- author
- Kobelt, Gisela LU ; Lekander, Ingrid ; Lang, Andrea ; Raffeiner, Bernd ; Botsios, Costantino and Geborek, Pierre LU
- organization
- publishing date
- 2011
- 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] < 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}}, }