Modelling the cost effectiveness of TNF-α antagonists in the management of rheumatoid arthritis: results from the British Society for Rheumatology Biologics Registry

• Published in: Rheumatology (Oxford, England) Vol. 46; no. 8; pp. 1345 - 1354
• Main Authors: Brennan, A., Bansback, N., Nixon, R., Madan, J., Harrison, M., Watson, K., Symmons, D.
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-08-2007
• Subjects: Aged; Anti-TNF; Antirheumatic Agents - economics; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - drug therapy; Arthritis, Rheumatoid - economics; Biological and medical sciences; Computer Simulation; cost; Cost-Benefit Analysis; cost-effectiveness; Diseases of the osteoarticular system; Drug Costs - statistics & numerical data; Epidemiologic Methods; Female; Health Care Costs - statistics & numerical data; Humans; Immunologic Factors - economics; Immunologic Factors - therapeutic use; Inflammatory joint diseases; Male; Medical sciences; Middle Aged; Models, Econometric; Quality-Adjusted Life Years; rheumatoid arthritis; Severity of Illness Index; Treatment Outcome; Tumor Necrosis Factor-alpha - antagonists & inhibitors; United Kingdom; Anti-TNF; cost-effectiveness; cost; rheumatoid arthritis; Immunopathology; Costs; Cytokine; Diseases of the osteoarticular system; Rheumatology; Autoimmune disease; Inflammatory joint disease; Modeling; Chronic; Tumor necrosis factor; Health economy; Rheumatoid arthritis; Antagonist; Public health; Tumor necrosis factor α
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kem115

Objective. To evaluate the cost effectiveness of TNF-α antagonist therapies for rheumatoid arthritis (RA) in the United Kingdom using data from the British Society for Rheumatology Biologics Registry (BSRBR). Methods. A simulation model is constructed to quantify the cost effectiveness of the TNF-α antagonist therapies (infliximab, etanercept and adalimumab) as a group versus traditional disease-modifying anti-rheumatic drugs, with a time horizon over the full patient lifetime. Participants are UK NHS patients in the BSRBR with RA who have failed at least two traditional disease-modifying anti-rheumatic drugs. The BSRBR aims to recruit all RA patients starting on a TNF-α antagonist agent and follows them 6 monthly via consultant and patient administered questionnaires. Data collected include disease activity scores (DAS28), the Health Assessment Questionnaire and the SF-36. Costs include drug, monitoring and hospitalisations. Benefits are measured in disability and quality of life improvements. The main outcome measure is the incremental cost per quality adjusted life-year gained (discounted). Results. The basecase cost per quality adjusted life-year gained by using TNF-α antagonist therapies is estimated at £23 882, with probabilistic uncertainty analysis suggesting that the probability that treatments are below £30 000 per QALY is around 84%. The results are most sensitive to assumptions concerning long-term disability progression, discount rates and the validity or otherwise of SF6D derived utility measures. Subgroup analysis, monotherapy versus combination with methotrexate, and a limited analysis of sequential therapy with two TNF-α antagonist agents, suggest cost-effectiveness ratios around £20 000 to £30 000. Conclusions. The BSRBR data provide valuable evidence for estimating cost-effectiveness. The analysis concludes that current policies and practice for the use of TNF-α antagonist therapies, after RA patients have failed at least two traditional disease-modifying anti-rheumatic drugs, appear cost-effective in the context of the NICE re-appraisal of 2006 for England and Wales, thus supporting their decision to continue their reimbursement. Decision-makers worldwide might adapt this analysis because differential costs, discount rates and other factors could affect results. There remains uncertainty, particularly on long-term disease progression. Further data collection using the BSRBR is recommended, together with a revision to this analysis when data become available.