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Cost-effectiveness of infliximab versus conventional combination treatment in methotrexate-refractory early rheumatoid arthritis: 2-year results of the register-enriched randomised controlled SWEFOT trial.

Eriksson, Jonas; Karlsson, Johan LU ; Bratt, Johan; Petersson, Ingemar LU ; van Vollenhoven, Ronald; Ernestam, Sofia; Geborek, Pierre LU and Neovius, Martin (2015) In Annals of the Rheumatic Diseases 74(6). p.1094-1101
Abstract
OBJECTIVE:

To estimate the incremental cost-effectiveness of infliximab versus conventional combination treatment over 21 months in patients with methotrexate-refractory early rheumatoid arthritis.



METHODS:

In this multicentre, two-arm, parallel, randomised, active-controlled, open-label trial, rheumatoid arthritis patients with <1 year symptom duration were recruited from 15 rheumatology clinics in Sweden between October 2002 and December 2005. After 3-4 months of methotrexate monotherapy, patients not achieving low disease activity were randomised to addition of infliximab or sulfasalazine+hydroxychloroquine (conventional treatment group). Costs of drugs, healthcare use, and productivity losses... (More)
OBJECTIVE:

To estimate the incremental cost-effectiveness of infliximab versus conventional combination treatment over 21 months in patients with methotrexate-refractory early rheumatoid arthritis.



METHODS:

In this multicentre, two-arm, parallel, randomised, active-controlled, open-label trial, rheumatoid arthritis patients with <1 year symptom duration were recruited from 15 rheumatology clinics in Sweden between October 2002 and December 2005. After 3-4 months of methotrexate monotherapy, patients not achieving low disease activity were randomised to addition of infliximab or sulfasalazine+hydroxychloroquine (conventional treatment group). Costs of drugs, healthcare use, and productivity losses were retrieved from nationwide registers, while EuroQol 5-Dimensions utility was collected quarterly.



RESULTS:

Of 487 patients initially enrolled, 128 and 130 were randomised to infliximab and conventional treatment, respectively. The infliximab group accumulated higher drug and healthcare costs (€27 487 vs €10 364; adjusted mean difference €16 956 (95% CI 14 647 to 19 162)), while productivity losses did not differ (€33 804 vs €29 220; €3961 (95% CI -3986 to 11 850)), resulting in higher societal cost compared to the conventional group (€61 291 vs €39 584; €20 916 (95% CI 12 800 to 28 660)). Mean accumulated quality-adjusted life-years (QALYs) did not differ (1.10 vs 1.12; adjusted mean difference favouring infliximab treatment 0.01 (95% CI -0.07 to 0.08)). The incremental cost-effectiveness ratios for the infliximab versus conventional treatment strategy were €2 404 197/QALY from the societal perspective and €1 948 919/QALY from the healthcare perspective.



CONCLUSIONS:

In early, methotrexate-refractory rheumatoid arthritis, a treatment strategy commencing with addition of infliximab, as compared to sulfasalazine+hydroxychloroquine, was not cost-effective over 21 months at willingness to pay levels generally considered acceptable.



TRIAL REGISTRATION NUMBER:

NCT00764725. (Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Cost-effectiveness, QALY, randomised clinical trial, register, rheumatoid arthritis.
in
Annals of the Rheumatic Diseases
volume
74
issue
6
pages
1094 - 1101
publisher
British Medical Association
external identifiers
  • wos:000354371200022
  • scopus:84932616840
ISSN
1468-2060
DOI
10.1136/annrheumdis-2013-205060
language
English
LU publication?
yes
id
e9c4a2d2-b7cf-4aea-a486-a742408b711a (old id 4779049)
date added to LUP
2015-06-29 08:24:55
date last changed
2017-11-12 03:38:37
@article{e9c4a2d2-b7cf-4aea-a486-a742408b711a,
  abstract     = {OBJECTIVE: <br/><br>
To estimate the incremental cost-effectiveness of infliximab versus conventional combination treatment over 21 months in patients with methotrexate-refractory early rheumatoid arthritis.<br/><br>
<br/><br>
METHODS: <br/><br>
In this multicentre, two-arm, parallel, randomised, active-controlled, open-label trial, rheumatoid arthritis patients with &lt;1 year symptom duration were recruited from 15 rheumatology clinics in Sweden between October 2002 and December 2005. After 3-4 months of methotrexate monotherapy, patients not achieving low disease activity were randomised to addition of infliximab or sulfasalazine+hydroxychloroquine (conventional treatment group). Costs of drugs, healthcare use, and productivity losses were retrieved from nationwide registers, while EuroQol 5-Dimensions utility was collected quarterly.<br/><br>
<br/><br>
RESULTS: <br/><br>
Of 487 patients initially enrolled, 128 and 130 were randomised to infliximab and conventional treatment, respectively. The infliximab group accumulated higher drug and healthcare costs (€27 487 vs €10 364; adjusted mean difference €16 956 (95% CI 14 647 to 19 162)), while productivity losses did not differ (€33 804 vs €29 220; €3961 (95% CI -3986 to 11 850)), resulting in higher societal cost compared to the conventional group (€61 291 vs €39 584; €20 916 (95% CI 12 800 to 28 660)). Mean accumulated quality-adjusted life-years (QALYs) did not differ (1.10 vs 1.12; adjusted mean difference favouring infliximab treatment 0.01 (95% CI -0.07 to 0.08)). The incremental cost-effectiveness ratios for the infliximab versus conventional treatment strategy were €2 404 197/QALY from the societal perspective and €1 948 919/QALY from the healthcare perspective.<br/><br>
<br/><br>
CONCLUSIONS: <br/><br>
In early, methotrexate-refractory rheumatoid arthritis, a treatment strategy commencing with addition of infliximab, as compared to sulfasalazine+hydroxychloroquine, was not cost-effective over 21 months at willingness to pay levels generally considered acceptable.<br/><br>
<br/><br>
TRIAL REGISTRATION NUMBER: <br/><br>
NCT00764725.},
  author       = {Eriksson, Jonas and Karlsson, Johan and Bratt, Johan and Petersson, Ingemar and van Vollenhoven, Ronald and Ernestam, Sofia and Geborek, Pierre and Neovius, Martin},
  issn         = {1468-2060},
  keyword      = {Cost-effectiveness,QALY,randomised clinical trial,register,rheumatoid arthritis.},
  language     = {eng},
  number       = {6},
  pages        = {1094--1101},
  publisher    = {British Medical Association},
  series       = {Annals of the Rheumatic Diseases},
  title        = {Cost-effectiveness of infliximab versus conventional combination treatment in methotrexate-refractory early rheumatoid arthritis: 2-year results of the register-enriched randomised controlled SWEFOT trial.},
  url          = {http://dx.doi.org/10.1136/annrheumdis-2013-205060},
  volume       = {74},
  year         = {2015},
}