Dakin, H. orcid.org/0000-0003-3255-748X, Rombach, I. orcid.org/0000-0003-3464-3867, Dritsaki, M. orcid.org/0000-0002-1673-3036 et al. (4 more authors) (2022) Cost-effectiveness of adalimumab for early-stage Dupuytren’s disease. Bone & Joint Open, 3 (11). pp. 898-906. ISSN 2633-1462
Abstract
Aims: To estimate the potential cost-effectiveness of adalimumab compared with standard care alone for the treatment of early-stage Dupuytren’s disease (DD) and the value of further research from an NHS perspective.
Methods: We used data from the Repurposing anti-TNF for Dupuytren’s disease (RIDD) randomized controlled trial of intranodular adalimumab injections in patients with early-stage progressive DD. RIDD found that intranodular adalimumab injections reduced nodule hardness and size in patients with early-stage DD, indicating the potential to control disease progression. A within-trial cost-utility analysis compared four adalimumab injections with no further treatment against standard care alone, taking a 12-month time horizon and using prospective data on EuroQol five-dimension five-level questionnaire (EQ-5D-5L) and resource use from the RIDD trial. We also developed a patient-level simulation model similar to a Markov model to extrapolate trial outcomes over a lifetime using data from the RIDD trial and a literature review. This also evaluated repeated courses of adalimumab each time the nodule reactivated (every three years) in patients who initially responded.
Results: The within-trial economic evaluation found that adalimumab plus standard care cost £503,410 per quality-adjusted life year (QALY) gained versus standard care alone over a 12-month time horizon. The model-based extrapolation suggested that, over a lifetime, repeated courses of adalimumab could cost £14,593 (95% confidence interval £7,534 to £42,698) per QALY gained versus standard care alone. If the NHS was willing to pay £20,000/QALY gained, there is a 77% probability that adalimumab with retreatment is the best value for money.
Conclusion: Repeated courses of adalimumab are likely to be a cost-effective treatment for progressive early-stage DD. The value of perfect parameter information that would eliminate all uncertainty around the parameters estimated in RIDD and the duration of quiescence was estimated to be £105 per patient or £272 million for all 2,584,411 prevalent cases in the UK.
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © 2022 Author(s) et al. Open Access: This article is distributed under the terms of the Creative Commons Attributions (CC BY 4.0) licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original author and source are credited. |
Keywords: | Adalimumab; Anti-tumour necrosis factor; Cost-effectiveness analysis; Dupuytren’s disease; EQ-5D-5L; Economic evaluation; Palmar fibromatosis; Randomized controlled trial; Simulation model; flexion deformities; linear regression models; percutaneous needle fasciotomies; radiotherapy; randomized controlled trials; sensitivity analysis; steroid injections |
Dates: |
|
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 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 24 Jan 2023 16:00 |
Last Modified: | 24 Jan 2023 16:00 |
Status: | Published |
Publisher: | British Editorial Society of Bone & Joint Surgery |
Refereed: | Yes |
Identification Number: | 10.1302/2633-1462.311.bjo-2022-0103.r2 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:195630 |