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- Title
Modelling the cost effectiveness of TNF-{alpha} antagonists in the management of rheumatoid arthritis: results from the British Society for Rheumatology Biologics Registry.
- Authors
A. Brennan; N. Bansback; R. Nixon; J. Madan; M. Harrison; K. Watson; D. Symmons
- Abstract
Objective. To evaluate the cost effectiveness of TNF-α antagonist therapies for rheumatoid arthritis (RA) in the United Kingdom using data from the British Society for Rheumatology Biologics Registry (BSRBR). Methods. A simulation model is constructed to quantify the cost effectiveness of the TNF-α antagonist therapies (infliximab, etanercept and adalimumab) as a group versus traditional disease-modifying anti-rheumatic drugs, with a time horizon over the full patient lifetime. Participants are UK NHS patients in the BSRBR with RA who have failed at least two traditional disease-modifying anti-rheumatic drugs. The BSRBR aims to recruit all RA patients starting on a TNF-α antagonist agent and follows them 6 monthly via consultant and patient administered questionnaires. Data collected include disease activity scores (DAS28), the Health Assessment Questionnaire and the SF-36. Costs include drug, monitoring and hospitalisations. Benefits are measured in disability and quality of life improvements. The main outcome measure is the incremental cost per quality adjusted life-year gained (discounted). Results. The basecase cost per quality adjusted life-year gained by using TNF-α antagonist therapies is estimated at £23â882, with probabilistic uncertainty analysis suggesting that the probability that treatments are below £30â000 per QALY is around 84%. The results are most sensitive to assumptions concerning long-term disability progression, discount rates and the validity or otherwise of SF6D derived utility measures. Subgroup analysis, monotherapy versus combination with methotrexate, and a limited analysis of sequential therapy with two TNF-α antagonist agents, suggest cost-effectiveness ratios around £20â000 to £30â000. Conclusions. The BSRBR data provide valuable evidence for estimating cost-effectiveness. The analysis concludes that current policies and practice for the use of TNF-α antagonist therapies, after RA patients have failed at least two traditional disease-modifying anti-rheumatic drugs, appear cost-effective in the context of the NICE re-appraisal of 2006 for England and Wales, thus supporting their decision to continue their reimbursement. Decision-makers worldwide might adapt this analysis because differential costs, discount rates and other factors could affect results. There remains uncertainty, particularly on long-term disease progression. Further data collection using the BSRBR is recommended, together with a revision to this analysis when data become available.
- Subjects
COST effectiveness; TUMOR necrosis factors; RHEUMATOID arthritis treatment; CLINICAL medicine research
- Publication
Rheumatology, 2007, Vol 46, Issue 8, p1345
- ISSN
1462-0324
- Publication type
Article
- DOI
10.1093/rheumatology/kem115