Brennan, A., Bansback, N., Nixon, R., Madan, Jason, Harrison, M., Watson, K. and Symmons, D. (2007) Modelling the cost effectiveness of TNF-α antagonists in the management of rheumatoid arthritis : Results from the British Society for Rheumatology Biologics Registry. Rheumatology, 46 (8). 1345- 1354. doi:10.1093/rheumatology/kem115

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Abstract

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. © The Author 2007.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General)
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Journal or Publication Title:	Rheumatology
Publisher:	Oxford University Press
ISSN:	1462-0324
Official Date:	18 September 2007
Dates:	Date Event 18 September 2007 Published
Volume:	46
Number:	8
Page Range:	1345- 1354
DOI:	10.1093/rheumatology/kem115
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
Funder:	Amgen, Abbott Laboratories, University of Manchester, British School at Rome, British Society for Rheumatology, Metropolitan Museum of Art, University of Sheffield
Grant number:	10000

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