Cost-effectiveness modelling of sequential biologic strategies for the treatment of moderate to severe rheumatoid arthritis in Finland.

Q4 Medicine

Open Rheumatology Journal Pub Date : 2012-01-01 Epub Date: 2012-04-26 DOI:10.2174/1874312901206010038

K Puolakka, H Blåfield, M Kauppi, R Luosujärvi, R Peltomaa, T Leikola-Pelho, K Sennfalt, A Beresniak

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引用次数: 21

Abstract

Objective: The main objective was to compare the cost-effectiveness of therapeutic options in moderate or severe rheumatoid arthritis (RA) when a clinical response to a first TNF-blocker, either etanercept (ETA), adalimumab (ADA), or infliximab (INF), is insufficient.

Methods: Effectiveness criteria were defined as remission (RS), low disease activity (LDAS), and moderate to high disease activity (MHDAS). Cost-effectiveness was derived as cost per day in RS and in LDAS using simulation modelling to assess six sequential biologic strategies over 2 years. Each sequential treatment strategy was composed of three biologic agents and included a first anti-TNF agent, ETA, ADA or INF, followed by either abatacept (ABA) or rituximab (RTX) as a second therapeutic option in case of an insufficient response, followed by another anti-TNF agent in case of further insufficient response.

Results: Over two years and taking into account biologic costs, the following estimated mean costs per day in RS and LDAS were respectively of €829 and €428 for the biologic sequence composed of ADA-ABA-ETA, €1292 and €516 for the sequence ADA-RTX-ETA, €829 and €429 for the sequence ETA-ABA-ADA, €1292 and €517 for the sequence ETARTX- ADA, €840 and €434 for the sequence INF-ABA-ETA, and €1309 and €523 for the sequence INF-RTX-ETA.

Conclusion: The treatment sequences including ABA as the second biologic option appear more cost-effective than those including RTX in a patients with moderate to severe RA and an insufficient response to a first anti-TNF agent.

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芬兰中重度类风湿关节炎序贯生物学治疗策略的成本-效果模型

目的:主要目的是比较中度或重度类风湿性关节炎(RA)的治疗方案的成本效益，当对第一种tnf阻滞剂，依那西普(ETA)，阿达木单抗(ADA)或英夫利昔单抗(INF)的临床反应不足时。方法:将疗效标准定义为缓解(RS)、低疾病活动性(LDAS)和中高疾病活动性(MHDAS)。成本效益是RS和LDAS每天的成本，使用模拟模型评估2年内的6种顺序生物策略。每个顺序治疗策略由三种生物制剂组成，包括第一种抗tnf药物，ETA, ADA或INF，然后是阿巴接受(ABA)或利妥昔单抗(RTX)作为第二种治疗选择，以防反应不足，然后是另一种抗tnf药物，以防进一步反应不足。结果:在两年的时间里，考虑到生物成本，由ADA- aba - eta组成的生物序列在RS和LDAS中每天的估计平均成本分别为829欧元和428欧元，ADA- rtx - eta序列为1292欧元和516欧元，ETA-ABA-ADA序列为829欧元和429欧元，ETARTX- ADA序列为1292欧元和517欧元，INF-ABA-ETA序列为840欧元和434欧元，INF-RTX-ETA序列为1309欧元和523欧元。结论:在对第一种抗tnf药物反应不足的中重度RA患者中，包括ABA作为第二生物选择的治疗序列比包括RTX的治疗序列更具成本效益。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Open Rheumatology Journal Medicine-Rheumatology

CiteScore

0.80

自引率

0.00%

发文量

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