Matt D Stevenson1,2, Allan J Wailoo3,4, Jonathan C Tosh3,4, Monica Hernandez-Alava3,4, Laura A Gibson3,4, John W Stevens3,4, Rachel J Archer3,4, Emma L Simpson3,4, Emma S Hock3,4, Adam Young3,4, David L Scott3,4. 1. From the School of Health and Related Research, University of Sheffield, Sheffield; Department of Rheumatology, West Hertfordshire Hospitals National Health Service (NHS) Trust, Hertfordshire; Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK. m.d.stevenson@shef.ac.uk. 2. M.D. Stevenson, PhD, Professor of Health Technology Assessment, School of Health and Related Research, University of Sheffield; A.J. Wailoo, PhD, Professor of Health Economics, School of Health and Related Research, University of Sheffield; J.C. Tosh, PhD, Research Fellow in Health Economics, School of Health and Related Research, University of Sheffield; M. Hernandez-Alava, PhD, Senior Research Fellow in Econometrics, School of Health and Related Research, University of Sheffield; L.A. Gibson, PhD, Research Associate in Econometrics, School of Health and Related Research, University of Sheffield; J.W. Stevens, PhD, Reader in Decision Science, School of Health and Related Research, University of Sheffield; R.J. Archer, PhD, Research Fellow, School of Health and Related Research, University of Sheffield; E.L. Simpson, PhD, Research Fellow, School of Health and Related Research, University of Sheffield, E.S. Hock, PhD, Research Fellow, School of Health and Related Research, University of Sheffield; A. Young, FRCP, Professor of Clinical Rheumatology, Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; D.L. Scott, MD, FRCP, Professor of Clinical Rheumatology, Department of Rheumatology, King's College Hospital NHS Foundation Trust. m.d.stevenson@shef.ac.uk. 3. From the School of Health and Related Research, University of Sheffield, Sheffield; Department of Rheumatology, West Hertfordshire Hospitals National Health Service (NHS) Trust, Hertfordshire; Department of Rheumatology, King's College Hospital NHS Foundation Trust, London, UK. 4. M.D. Stevenson, PhD, Professor of Health Technology Assessment, School of Health and Related Research, University of Sheffield; A.J. Wailoo, PhD, Professor of Health Economics, School of Health and Related Research, University of Sheffield; J.C. Tosh, PhD, Research Fellow in Health Economics, School of Health and Related Research, University of Sheffield; M. Hernandez-Alava, PhD, Senior Research Fellow in Econometrics, School of Health and Related Research, University of Sheffield; L.A. Gibson, PhD, Research Associate in Econometrics, School of Health and Related Research, University of Sheffield; J.W. Stevens, PhD, Reader in Decision Science, School of Health and Related Research, University of Sheffield; R.J. Archer, PhD, Research Fellow, School of Health and Related Research, University of Sheffield; E.L. Simpson, PhD, Research Fellow, School of Health and Related Research, University of Sheffield, E.S. Hock, PhD, Research Fellow, School of Health and Related Research, University of Sheffield; A. Young, FRCP, Professor of Clinical Rheumatology, Centre for Lifespan and Chronic Illness Research, University of Hertfordshire; D.L. Scott, MD, FRCP, Professor of Clinical Rheumatology, Department of Rheumatology, King's College Hospital NHS Foundation Trust.
Abstract
OBJECTIVE: To ascertain whether strategies of treatment with a biological disease-modifying antirheumatic drug (bDMARD) are cost-effective in an English setting. Results are presented for those patients with moderate to severe rheumatoid arthritis (RA) and those with severe RA. METHODS: An economic model to assess the cost-effectiveness of 7 bDMARD was developed. A systematic literature review and network metaanalysis was undertaken to establish relative clinical effectiveness. The results were used to populate the model, together with estimates of Health Assessment Questionnaire (HAQ) score following European League Against Rheumatism response; annual costs, and utility, per HAQ band; trajectory of HAQ for patients taking bDMARD; and trajectory of HAQ for patients using nonbiologic therapy (NBT). Results were presented as those associated with the strategy with the median cost-effectiveness. Supplementary analyses were undertaken assessing the change in cost-effectiveness when only patients with the most severe prognoses taking NBT were provided with bDMARD treatment. The costs per quality-adjusted life-year (QALY) values were compared with reported thresholds from the UK National Institute for Health and Care Excellence of £20,000 to £30,000 (US$24,700 to US$37,000). RESULTS: In the primary analyses, the cost per QALY of a bDMARD strategy was £41,600 for patients with severe RA and £51,100 for those with moderate to severe RA. Under the supplementary analyses, the cost per QALY fell to £25,300 for those with severe RA and to £28,500 for those with moderate to severe RA. CONCLUSION: The cost-effectiveness of bDMARD in RA in England is questionable and only meets current accepted levels in subsets of patients with the worst prognoses.
OBJECTIVE: To ascertain whether strategies of treatment with a biological disease-modifying antirheumatic drug (bDMARD) are cost-effective in an English setting. Results are presented for those patients with moderate to severe rheumatoid arthritis (RA) and those with severe RA. METHODS: An economic model to assess the cost-effectiveness of 7 bDMARD was developed. A systematic literature review and network metaanalysis was undertaken to establish relative clinical effectiveness. The results were used to populate the model, together with estimates of Health Assessment Questionnaire (HAQ) score following European League Against Rheumatism response; annual costs, and utility, per HAQ band; trajectory of HAQ for patients taking bDMARD; and trajectory of HAQ for patients using nonbiologic therapy (NBT). Results were presented as those associated with the strategy with the median cost-effectiveness. Supplementary analyses were undertaken assessing the change in cost-effectiveness when only patients with the most severe prognoses taking NBT were provided with bDMARD treatment. The costs per quality-adjusted life-year (QALY) values were compared with reported thresholds from the UK National Institute for Health and Care Excellence of £20,000 to £30,000 (US$24,700 to US$37,000). RESULTS: In the primary analyses, the cost per QALY of a bDMARD strategy was £41,600 for patients with severe RA and £51,100 for those with moderate to severe RA. Under the supplementary analyses, the cost per QALY fell to £25,300 for those with severe RA and to £28,500 for those with moderate to severe RA. CONCLUSION: The cost-effectiveness of bDMARD in RA in England is questionable and only meets current accepted levels in subsets of patients with the worst prognoses.
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Keywords:
ANTIRHEUMATIC AGENTS; COST-BENEFIT ANALYSIS; MEDICAL ECONOMICS; RHEUMATOID ARTHRITIS
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