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.
(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:
https://lup.lub.lu.se/record/4779049
- author
- Eriksson, Jonas ; Karlsson, Johan LU ; Bratt, Johan ; Petersson, Ingemar LU ; van Vollenhoven, Ronald ; Ernestam, Sofia ; Geborek, Pierre LU and Neovius, Martin
- organization
- publishing date
- 2015
- 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
- BMJ Publishing Group
- external identifiers
-
- wos:000354371200022
- scopus:84932616840
- pmid:24737786
- 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
- 2016-04-01 13:32:55
- date last changed
- 2022-03-21 19:08:27
@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 <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}},
keywords = {{Cost-effectiveness; QALY; randomised clinical trial; register; rheumatoid arthritis.}},
language = {{eng}},
number = {{6}},
pages = {{1094--1101}},
publisher = {{BMJ Publishing Group}},
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}},
doi = {{10.1136/annrheumdis-2013-205060}},
volume = {{74}},
year = {{2015}},
}