Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-30T20:14:33.907Z Has data issue: false hasContentIssue false
  • English
  • Français

Cost-effectiveness of etanercept treatment in early active rheumatoid arthritis followed by dose adjustment

Published online by Cambridge University Press:  08 July 2011

Gisela Kobelt ,
Ingrid Lekander ,
Andrea Lang ,
Bernd Raffeiner ,
Costantino Botsios  and
Pierre Geborek
Gisela Kobelt
Affiliation:
Lund University and European Health Economics
Ingrid Lekander
Affiliation:
Karolinska Institute and i3 innovus
Andrea Lang
Affiliation:
i3 innovus
Bernd Raffeiner
Affiliation:
University of Padova
Costantino Botsios
Affiliation:
University of Padova
Pierre Geborek
Affiliation:
Lund University and Skåne University Hospital Malmö (SUS)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: To explore the cost-effectiveness of early biologic treatment, followed by dose-reduction in the case of remission, of active rheumatoid arthritis (RA), compared with standard treatment with methotrexate (MTX) in Sweden.

Methods: Effectiveness (function, disease activity, erosions) in early RA for both alternatives was taken from a clinical trial comparing etanercept (ETA) combined with MTX to MTX alone. Patients discontinuing treatment can switch to another or their first biologic treatment. For patients in remission (Disease Activity Score [DAS28] < 2.6), ETA is reduced to half the dose. Return to full dose occurs when DAS28 reaches ≥ 3.2 again. Costs and utilities by level of functional capacity from an observational study are used. The model is analyzed as a micro-simulation and results are presented from the societal perspective for Sweden, for 10 years; costs (€2008) and effects are discounted at 3 percent. Sensitivity analysis was performed for the perspective, the time horizon, switching, and dose-reduction.

Results: The main analysis conservatively assumes 50 percent switching at discontinuation. The cost per quality-adjusted life-year (QALY) gained with early ETA/MTX treatment is €13,500 (societal perspective, incremental cost of €15,500 and incremental QALYs of 1.15). With 75 percent switching, the cost per QALY gained was €10,400. Over 20 years, the cost per QALY gained was €8,200. Results were further sensitive to the time patients remained on half dose and the perspective.

Conclusions and Policy Implications: This study combines clinical trial and clinical practice data to explore cost-effective treatment scenarios in early RA, including the use of biologics. Our results indicate that a situation where a considerable proportion of patients achieve remission, dose-adjustments will increase the cost-effectiveness of treatment.

Keywords

Rheumatoid arthritisEtanerceptDose reductionCost-effectivenessSweden
Type
ASSESSMENTS
Information
International Journal of Technology Assessment in Health Care , Volume 27 , Issue 3 , July 2011 , pp. 193 - 200
Copyright
Copyright © Cambridge University Press 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Bansback, NJ, Brennan, A, Ghatnekar, O. Cost effectiveness of adalimumab in the treatment of patients with moderate to severe rheumatoid arthritis in Sweden. Ann Rheum Dis. 2005;64:995–1002.CrossRefGoogle ScholarPubMed
2. Botsios, C, Furlan, A, Ostuni, P, et al. Effects of low-dose etanercept in maintaining DAS-remission previously achieved with standrad dose in patients with rheumatoid arthritis. Ann Rheum Dis. 2009;66:54.Google Scholar
3. Breedveld, FC, Weisman, MH, Kavanaugh, AF, et al. The PREMIER study: A multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum. 2006;54:26–37.CrossRefGoogle Scholar
4. Brocq, O, Millasseau, E, Albert, C, et al. Effect of discontinuing TNFalpha antagonist therapy in patients with remission of rheumatoid arthritis. Joint Bone Spine. 2009;76:350–355.CrossRefGoogle ScholarPubMed
5. Combe, B, Landewe, R, Lukas, C, et al. EULAR recommendations for the management of early arthritis: Report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2007;66:34–45.CrossRefGoogle ScholarPubMed
6. Emery, P, Breedveld, F, Heijde, Dvd, et al. Two-year clinical and radiographic results with combination etanercept-methotrexate therapy versus monotherapy in early rheumatoid arthritis: A two-year, double-blind, randomized study. Arthritis Rheum. 2010;62:674–682.CrossRefGoogle ScholarPubMed
7. The EuroQol Group. EuroQol - a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.CrossRefGoogle Scholar
8. Gabriel, SE, Crowson, CS, Kremers, HM, et al. Survival in rheumatoid arthritis: A population-based analysis of trends over 40 years. Arthritis Rheum. 2003;48:54–58.CrossRefGoogle ScholarPubMed
9. Geborek, P, Saxne, T. Clinical protocol for monitoring of targeted therapies in rheumatoid arthritis. Rheumatology (Oxford). 2000;39:1159–1161.Google Scholar
10. Jacobsson, LT, Lindroth, Y, Marsal, L, et al. Rheumatoid arthritis: What does it cost and what factors are driving those costs? Results of a survey in a community-derived population in Malmo, Sweden. Scand J Rheumatol. 2007;36:179–183.Google Scholar
11. Jonsson, B. Ten arguments for a societal perspective in the economic evaluation of medical innovations. Eur J Health Econ. 2009;10:357–359.CrossRefGoogle ScholarPubMed
12. Karlsson, JA, Kristensen, LE, Kapetanovic, MC, et al. Treatment response to a second or third TNF inhibitor in RA: Results from the South Swedish Arthritis Treatment Group Register. Rheumatology (Oxford). 2008;47:507–513.CrossRefGoogle ScholarPubMed
13. Kobelt, G, Eberhardt, K, Geborek, P. TNF inhibitors in the treatment of rheumatoid arthritis in clinical practice: Costs and outcomes in a follow up study of patients with RA treated with etanercept or infliximab in southern Sweden. Ann Rheum Dis. 2004;63:4–10.Google Scholar
14. Kobelt, G, Jönsson, L, Young, A, Eberhardt, K. The cost-effectiveness of infliximab (Remicade(R)) in the treatment of rheumatoid arthritis in Sweden and the United Kingdom based on the ATTRACT study. Rheumatology. 2003;42:326–335.CrossRefGoogle Scholar
15. Kobelt, G, Kasteng, F. Access to innovative treatments in rheumatpid arthritis in Europe. Lund, Sweden: Lund University; 2009. www.comparatorreports.se.Google Scholar
16. Kobelt, G, Lindgren, P, Geborek, P. Costs and outcomes for patients with rheumatoid arthritis treated with biological drugs in Sweden: A model based on registry data. Scand J Rheumatol. 2009;38:409–418.CrossRefGoogle Scholar
17. Kobelt, G, Lindgren, P, Singh, A, Klareskog, L. Cost effectiveness of etanercept (Enbrel) in combination with methotrexate in the treatment of active rheumatoid arthritis based on the TEMPO trial. Ann Rheum Dis. 2005;64:1174–1179.CrossRefGoogle ScholarPubMed
18. Lagana, B, Picchianti Diamanti, A, Ferlito, C, et al. Imaging progression despite clinical remission in early rheumatoid arthritis patients after etanercept interruption. Int J Immunopathol Pharmacol. 2009;22:447–454.CrossRefGoogle ScholarPubMed
19. Lekander, I, Borgstrom, F, Svarvar, P, et al. Cost-effectiveness of real-world infliximab use in patients with rheumatoid arthritis in Sweden. Int J Technol Assess Health Care. 2010;26:54–61.CrossRefGoogle ScholarPubMed
20. Lindqvist, E, Eberhardt, K. Mortality in rheumatoid arthritis patients with disease onset in the 1980s. Ann Rheum Dis. 1999;58:11–14.CrossRefGoogle ScholarPubMed
21. Nishimoto, N. Drug-free remission after cessation of actemra monotherapy (DREAM study). Ann Rheum Dis. 2010;69:98.Google Scholar
22. Scott, D, Pugner, K, Kaarela, K, et al. The links between joint damage and disability in rheumatoid arthritis. Rheumatology. 2000;39:122–132.Google Scholar
23. Smolen, JS, Aletaha, D, Bijlsma, JW, et al. Treating rheumatoid arthritis to target: Recommendations of an international task force. Ann Rheum Dis. 2010;69:631–637.Google Scholar
24. Smolen, JS, Landewe, R, Breedveld, FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis. 2010;69:964–975.Google Scholar
25. van der Kooij, SM, Goekoop-Ruiterman, YP, de Vries-Bouwstra, JK, et al. Drug-free remission, functioning and radiographic damage after 4 years of response-driven treatment in patients with recent-onset rheumatoid arthritis. Ann Rheum Dis. 2009;68:914–921.CrossRefGoogle ScholarPubMed
Supplementary material: File

Kobelt et al. supplementary material

Supplementary table and figure

Download Kobelt et al. supplementary material(File)
File 333.8 KB