Stevenson, M.D. orcid.org/0000-0002-3099-9877, Wailoo, A.J. orcid.org/0000-0002-9324-1617, Tosh, J.C. et al. (8 more authors) (2017) The cost-effectiveness of sequences of biological disease-modifying antirheumatic drug treatment in England for patients with rheumatoid arthritis who can tolerate methotrexate. Journal of Rheumatology, 44 (7). pp. 973-980. ISSN 0315-162X
Abstract
Objective: To ascertain whether strategies of treatment with a biological diseasemodifying antirheumatic drug (bDMARD) were 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 seven bDMARDs was developed. A systematic literature review and network meta-analysis was undertaken to establish relative clinical effectiveness. The results 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 on bDMARDs; and trajectory of HAQ for patients on non-biologic therapy (NBT) were used to populate the model. Results were presented as those associated with the strategy with the median cost-effectiveness. Supplementary analyses were undertaken assessing the change in cost-effectiveness where only patients with the most severe prognoses on NBT were provided with bDMARD treatment. The cost per QALY values were compared with reported thresholds from the National Institute for Health and Care Excellence of £20,000 to £30,000. 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 bDMARDs in RA in England is questionable and only meets current accepted levels in subsets of patients with the worst prognoses.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2017 Journal of Rheumatology. Reproduced in accordance with the publisher's self-archiving policy. |
Keywords: | Arthritis, Rheumatoid; Antirheumatic agents; Cost-Benefit Analysis; Economics, Medical |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > School of Health and Related Research (Sheffield) > ScHARR - Sheffield Centre for Health and Related Research |
Funding Information: | Funder Grant number NATIONAL INSTITUTE FOR HEALTH RESEARCH 14/25/02 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 01 Dec 2016 14:38 |
Last Modified: | 13 Jan 2020 11:09 |
Published Version: | https://doi.org/10.3899/jrheum.160941 |
Status: | Published |
Publisher: | Journal of Rheumatology |
Refereed: | Yes |
Identification Number: | 10.3899/jrheum.160941 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:108569 |