Cost-Effectiveness of TNF-Blocker Injection Spacing for Patients with Established Rheumatoid Arthritis in Remission- An Economic Evaluation from the Spacing of TNF-Blocker Injections in Rheumatoid Arthritis Trial

Apr 1, 2017, 00:00
10.1016/j.jval.2017.01.005
https://www.valueinhealthjournal.com/article/S1098-3015(17)30065-7/fulltext
Title : Cost-Effectiveness of TNF-Blocker Injection Spacing for Patients with Established Rheumatoid Arthritis in Remission- An Economic Evaluation from the Spacing of TNF-Blocker Injections in Rheumatoid Arthritis Trial
Citation : https://www.valueinhealthjournal.com/action/showCitFormats?pii=S1098-3015(17)30065-7&doi=10.1016/j.jval.2017.01.005
First page : 577
Section Title : Economic Evaluation
Open access? : No
Section Order : 7

Background

In patients with rheumatoid arthritis in remission, a disease activity–driven tapering of adalimumab or etanercept relying on progressive injection spacing has not been shown to be equivalent to a maintenance strategy at full dose in terms of disease activity in the Spacing of TNF-blocker injections in Rheumatoid ArthritiS Study (STRASS) trial.

Objectives

To evaluate the cost-effectiveness of such a spacing strategy based on the data of the STRASS trial.

Methods

This is a cost-utility analysis of the STRASS trial, a French multicenter 18-month equivalence randomized open-label controlled trial that included patients at stable dose for at least 1 year, in remission for at least 6 months. Effectiveness was assessed in quality-adjusted life-years (QALYs). Costs involved in the study period were assessed from a payer perspective. The decremental cost-effectiveness ratio (DCER) was calculated in the complete cases sample (n = 98). Several sensitivity analyses were conducted and the impact of missing data on DCER estimate was investigated. An acceptability analysis was performed.

Results

In the spacing arm, TNF-blockers were stopped for 34.1% of the patients, tapered for 43.2%, and maintained at full dose for 18.2%. The spacing strategy was associated with less QALYs gain (mean difference of −0.158; 95% confidence interval [CI] −0.085 to −0.232) and reduced costs (mean difference of −€8,440; 95% CI −6,507 to −10,212). The estimated DCER of the spacing strategy over the maintenance at full dose was €53,417 saved per QALY lost (95% CI 32,230 to 104,700).

Conclusions

The spacing strategy appears cost-effective, but the acceptability of such a QALY loss reported to the cost avoided remains to be evaluated, because no consensual threshold has been determined for willingness to accept as compared with willingness to pay.

Categories :
Tags :
  • cost-utility
  • health economics
  • rheumatoid arthritis
  • step-down strategy
  • treatment tapering
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