COST-EFFECTIVENESS AND COST-UTILITY ANALYSES COMPARING STRATEGIES FOR INITIAL TREATMENT OF RHEUMATOID ARTHRITIS USING PUBLISHED OUTCOMES- ECONOMIC LESSONS FROM THE TEAR TRIAL
Author(s)
Fuchs PA1, Lal L2, Fuchs HA3, Swint J4
1University of Texas Medical School at Houston, Houston, TX, USA, 2Cardinal Health, Missouri City, TX, USA, 3Vanderbilt University Medical Center, Nashville, TN, USA, 4University of Texas School of Public Health, Houston, TX, USA
OBJECTIVES: Controversy surrounds the most appropriate initial treatment regimen for Rheumatoid Arthritis. The objective of the present study is to aid in this debate by providing cost-effectiveness and cost-utility analyses for four treatment scenarios. METHODS: Estimates of costs were applied to outcome data from the Treatment of Early Aggressive Rheumatoid Arthritis (TEAR) Trial to determine cost-effectiveness. Treatment regimens from the TEAR trial, immediate etanercept (IE), immediate triple therapy (methotrexate, sulfasalazine, and hydroxychloroquine) (IT), step-up etanercept (SE), and step-up triple therapy (ST), were compared. Each regimen used methotrexate as a background medication. Outcomes analyzed include Disease Activity Scores (DAS-28-ESR) from the TEAR trial, calculated Clinical Disease Activity Index (CDAI) scores, and Quality-adjusted Life Years (QALYs) calculated using literature estimates. Discontinuers were assigned cost and outcome estimates based on duration of participation and associated outcomes. Analysis was limited to the two year time horizon of the TEAR trial. RESULTS: ST was cost-effective for all outcome measures, and had the highest net monetary benefit (NMB) for DAS-28-ESR ($592,569) and QALYs ($71,080), using a willingness to pay (WTP) of $250,000. IE was dominated for CDAI and had the lowest NMBs for DAS-28-ESR and QALYs, with incremental cost-effectiveness ratios (ICERs) of $1,025,534 and $8,205,670, respectively. SE was dominated for all outcomes. Results from one-way and probabilistic sensitivity analysis were consistent with these findings. CONCLUSIONS: The treatment strategies using etanercept were more costly than triple therapy strategies, with similar outcomes and ICERs outside most acceptable levels. SE was not cost-effective for any outcome, and ST was a consistently cost-effective treatment strategy.
Conference/Value in Health Info
2015-11, ISPOR Europe 2015, Milan, Italy
Value in Health, Vol. 18, No. 7 (November 2015)
Code
PSY70
Topic
Economic Evaluation
Topic Subcategory
Cost-comparison, Effectiveness, Utility, Benefit Analysis
Disease
Systemic Disorders/Conditions