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The cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice

Lekander, Ingrid ; Borgstrom, Fredrik ; Lysholm, Jorgen ; van Vollenhoven, Ronald F. ; Lindblad, Staffan ; Geborek, Pierre LU and Kobelt, Gisela (2013) In European Journal of Health Economics 14(6). p.863-873
Abstract
The objective was to estimate the cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice, both as a first and second biological treatment, with or without the combination of conventional DMARDs. Further sub-group analysis of etanercept treatment was performed. Patient level data were obtained from three regions of the Swedish Rheumatology Registers. The dataset contained 2,558 patients who had started TNF-inhibitor treatment, 1,049 with etanercept as their first biological treatment. A total of 819 patients had switched to a second TNF-inhibitor, of which 425 to etanercept. A Markov cohort model was used in which health states of disease severity were classified according to HAQ and... (More)
The objective was to estimate the cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice, both as a first and second biological treatment, with or without the combination of conventional DMARDs. Further sub-group analysis of etanercept treatment was performed. Patient level data were obtained from three regions of the Swedish Rheumatology Registers. The dataset contained 2,558 patients who had started TNF-inhibitor treatment, 1,049 with etanercept as their first biological treatment. A total of 819 patients had switched to a second TNF-inhibitor, of which 425 to etanercept. A Markov cohort model was used in which health states of disease severity were classified according to HAQ and DAS28. Disease progression and discontinuation rates of TNF-inhibitors were based on the registry and for the comparator on published literature. Mortality, costs and utilities were based on Swedish data. The main analysis had a societal perspective over 20 years and efficacy was measured in quality-adjusted life-years (QALYs). TNF-inhibitor treatment was associated with an increase in QALYs and an incremental cost compared to no biological treatment. The cost per QALY gained with the three TNF-inhibitors ranged from a,not sign50,000 to a,not sign120,000, with lower estimates for TNF-inhibitors used in combination with MTX and as a first biologic. At a progression of 0.045 for the comparator, most values remain within the accepted range for cost-effectiveness. These results demonstrate that the cost per QALY for TNF-inhibitors was higher than in previous assessments based on registry data and that the results were sensitive to the HAQ progression of the comparator. (Less)
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author
; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Retrospective, Registry data, Disease progression, Etanercept, Cost-effectiveness analysis, Rheumatoid arthritis, Clinical practice, Sweden, Anti-TNF
in
European Journal of Health Economics
volume
14
issue
6
pages
863 - 873
publisher
Springer
external identifiers
  • wos:000326111200003
  • scopus:84888432068
  • pmid:22990378
ISSN
1618-7601
DOI
10.1007/s10198-012-0431-6
language
English
LU publication?
yes
id
c43558da-0212-4ec6-a951-bbc0127f526c (old id 4212528)
date added to LUP
2016-04-01 10:01:09
date last changed
2022-04-12 01:09:23
@article{c43558da-0212-4ec6-a951-bbc0127f526c,
  abstract     = {{The objective was to estimate the cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice, both as a first and second biological treatment, with or without the combination of conventional DMARDs. Further sub-group analysis of etanercept treatment was performed. Patient level data were obtained from three regions of the Swedish Rheumatology Registers. The dataset contained 2,558 patients who had started TNF-inhibitor treatment, 1,049 with etanercept as their first biological treatment. A total of 819 patients had switched to a second TNF-inhibitor, of which 425 to etanercept. A Markov cohort model was used in which health states of disease severity were classified according to HAQ and DAS28. Disease progression and discontinuation rates of TNF-inhibitors were based on the registry and for the comparator on published literature. Mortality, costs and utilities were based on Swedish data. The main analysis had a societal perspective over 20 years and efficacy was measured in quality-adjusted life-years (QALYs). TNF-inhibitor treatment was associated with an increase in QALYs and an incremental cost compared to no biological treatment. The cost per QALY gained with the three TNF-inhibitors ranged from a,not sign50,000 to a,not sign120,000, with lower estimates for TNF-inhibitors used in combination with MTX and as a first biologic. At a progression of 0.045 for the comparator, most values remain within the accepted range for cost-effectiveness. These results demonstrate that the cost per QALY for TNF-inhibitors was higher than in previous assessments based on registry data and that the results were sensitive to the HAQ progression of the comparator.}},
  author       = {{Lekander, Ingrid and Borgstrom, Fredrik and Lysholm, Jorgen and van Vollenhoven, Ronald F. and Lindblad, Staffan and Geborek, Pierre and Kobelt, Gisela}},
  issn         = {{1618-7601}},
  keywords     = {{Retrospective; Registry data; Disease progression; Etanercept; Cost-effectiveness analysis; Rheumatoid arthritis; Clinical practice; Sweden; Anti-TNF}},
  language     = {{eng}},
  number       = {{6}},
  pages        = {{863--873}},
  publisher    = {{Springer}},
  series       = {{European Journal of Health Economics}},
  title        = {{The cost-effectiveness of TNF-inhibitors for the treatment of rheumatoid arthritis in Swedish clinical practice}},
  url          = {{http://dx.doi.org/10.1007/s10198-012-0431-6}},
  doi          = {{10.1007/s10198-012-0431-6}},
  volume       = {{14}},
  year         = {{2013}},
}