Advanced Search
MyIDEAS: Login

Cost Utility of Tumour Necrosis Factor-α Inhibitors for Rheumatoid Arthritis: An Application of Bayesian Methods for Evidence Synthesis in a Markov Model

Contents:

Author Info

  • Christine M. Nguyen

    (Veterans Affairs San Diego Healthcare System, San Diego, CA, USA)

  • Mark Bounthavong

    (Veterans Affairs San Diego Healthcare System, San Diego, CA, USA)

  • Margaret A.S. Mendes

    (Veterans Affairs San Diego Healthcare System, San Diego, CA, USA)

  • Melissa L.D. Christopher

    (Veterans Affairs San Diego Healthcare System, San Diego, CA, USA)

  • Josephine N. Tran

    (Veterans Affairs San Diego Healthcare System, San Diego, CA, USA)

  • Rashid Kazerooni

    (Veterans Affairs San Diego Healthcare System, San Diego, CA, USA)

  • Anthony P. Morreale

    (Veterans Affairs San Diego Healthcare System, San Diego, CA, USA)

Registered author(s):

    Abstract

    Background:Background: Rheumatoid arthritis (RA) is a chronic autoimmune disease that affects approximately 1.5 million people in the US. Tumour necrosis factor (TNF)-α inhibitors have been shown to effectively treat and maintain remission in patients with moderately to severely active RA compared with conventional agents. The high acquisition cost of TNF-α inhibitors prohibits access, which mandates economic investigations into their affordability. The lack of head-to-head comparisons between these agents makes it difficult to determine which agent is the most cost effective. Abstract: Objective:Objective: This study aimed to determine which TNF-α inhibitor was the most cost-effective agent for the treatment of moderately to severely active RA from the US healthcare payer's perspective. Abstract: Methods:Methods: A Markov model was constructed to analyse the cost utility of five TNF-α inhibitors (in combination with methotrexate [+MTX]) versus MTX monotherapy using Bayesian methods for evidence synthesis. The model had a cycle length of 3 months and an overall time horizon of 5 years. Transition probabilities and utility scores were based on published studies. Total direct costs were adjusted to year 2009 $US using the medical component of the Consumer Price Index. All costs and QALYs were discounted at a rate of 3% per year. Patient response to the different strategies was determined by the American College of Rheumatology (ACR)50 criteria. One-way and probabilistic sensitivity analyses (PSAs) were performed to test the robustness of the base-case scenario. The base-case scenario was changed to ACR20 criteria (scenario 1) and ACR70 criteria (scenario 2) to determine the model's robustness. Cost-effectiveness acceptability curves and cost-effectiveness frontiers were used to estimate the cost-effectiveness probability of each treatment strategy. A willingness-to-pay (WTP) threshold was defined as three times the US GDP per capita ($US139 143 per additional QALY gained). Primary results were presented as incremental cost-effective ratios (ICERs). Abstract: Results:Results: Etanercept+MTX was the most cost-effective treatment strategy in the base-case scenario up to a WTP threshold of $US546 449 per QALY gained. At a WTP threshold of greater than $US546 499 per QALY gained, certolizumab+MTX was the most cost-effective treatment strategy. One-way analyses showed that the base-case scenario was sensitive to the probability of achieving ACR50 criteria for MTX and each TNF-α inhibitor, and changes in the utility score for patients who achieved the ACR50 criteria. With the exception of infliximab, all of the TNF-α inhibitors were sensitive to drug cost per cycle. In the scenario analyses, certolizumab+MTX was a dominant treatment strategy using ACR20 criteria, but etanercept+MTX was a dominant treatment strategy using ACR70 criteria. Abstract: Conclusions:Conclusions: Etanercept+MTX was a cost-effective treatment strategy in the base-case scenario; however, the model was sensitive to parameter uncertainties and ACR response criteria. Although Bayesian methods were used to determine transition probabilities, future studies will need to focus on head-to-head comparisons of multiple TNF-α inhibitors to provide valid comparisons.

    Download Info

    If you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
    File URL: http://PharmacoEconomics.adisonline.com/pt/re/pec/pdfhandler.00019053-201230070-00004.pdf
    Download Restriction: Pay per view

    File URL: http://PharmacoEconomics.adisonline.com/pt/re/pec/fulltext.00019053-201230070-00004.htm
    Download Restriction: Pay per view

    As the access to this document is restricted, you may want to look for a different version under "Related research" (further below) or search for a different version of it.

    Bibliographic Info

    Article provided by Springer Healthcare | Adis in its journal PharmacoEconomics.

    Volume (Year): 30 (2012)
    Issue (Month): 7 ()
    Pages: 575-593

    as in new window
    Handle: RePEc:wkh:phecon:v:30:y:2012:i:7:p:575-593

    Contact details of provider:
    Web page: http://pharmacoeconomics.adisonline.com/

    Related research

    Keywords: Adalimumab; Certolizumab-pegol; Cost-utility; Disease-modifying-antirheumatics; Etanercept; Golimumab; Infliximab; Methotrexate; Rheumatoid-arthritis; Tumour-necrosis-factor-alpha-inhibitors.;

    Find related papers by JEL classification:

    References

    No references listed on IDEAS
    You can help add them by filling out this form.

    Citations

    Lists

    This item is not listed on Wikipedia, on a reading list or among the top items on IDEAS.

    Statistics

    Access and download statistics

    Corrections

    When requesting a correction, please mention this item's handle: RePEc:wkh:phecon:v:30:y:2012:i:7:p:575-593. See general information about how to correct material in RePEc.

    For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Dave Dustin).

    If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

    If references are entirely missing, you can add them using this form.

    If the full references list an item that is present in RePEc, but the system did not link to it, you can help with this form.

    If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your profile, as there may be some citations waiting for confirmation.

    Please note that corrections may take a couple of weeks to filter through the various RePEc services.