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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
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
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
2014-01-03 10:47:45
date last changed
2019-06-11 01:04:41
@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},
  keyword      = {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},
  volume       = {14},
  year         = {2013},
}