Cost-effectiveness of five different anti-tumour necrosis factor tapering strategies in rheumatoid arthritis: a modelling study
| Autor: | Lise M Verhoef, Bruno Fautrel, Marlies E J L Hulscher, Chm van den Ende, A.A. den Broeder, Wietske Kievit, Dpg Bos, Fhj van den Hoogen |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Oncology
medicine.medical_specialty Necrosis Cost effectiveness Cost-Benefit Analysis Immunology Tapering Arthritis Rheumatoid Disease activity 03 medical and health sciences 0302 clinical medicine Rheumatology Internal medicine medicine Humans Immunology and Allergy In patient 030212 general & internal medicine 030203 arthritis & rheumatology Tumor Necrosis Factor-alpha business.industry Anti tumour necrosis factor General Medicine medicine.disease Markov Chains lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4] Rheumatoid arthritis Inflammatory diseases Radboud Institute for Health Sciences [Radboudumc 5] Quality-Adjusted Life Years medicine.symptom business Decision Making Shared |
| Zdroj: | Scandinavian Journal of Rheumatology, 48, 6, pp. 439-447 Scandinavian Journal of Rheumatology, 48, 439-447 |
| ISSN: | 0300-9742 |
| DOI: | 10.6084/m9.figshare.8305985.v1 |
| Popis: | Objective: To investigate the cost-effectiveness of five different tumour necrosis factor inhibitor tapering strategies in patients with rheumatoid arthritis (RA) and stable low disease activity, using a modelling design. Method: Using Markov models based on data from the DRESS and STRASS randomized controlled trials, and the Nijmegen RA cohort, five tapering strategies for etanercept and adalimumab were tested against continuation: 1, four-step tapering (DRESS strategy); 2, five-step tapering; 3, tapering without withdrawal; 4, use of a stricter flare criterion; and 5, use of a theoretical predictor for successful tapering. We also examined how well a biomarker should be able to predict in order for strategy 5 to become cost-effective compared to the other strategies. Results: All examined tapering strategies were cost saving (range: EUR 5128 to 7873) but yielded more short-lived flares compared to continuation. The change in utilities compared to continuation was minimal and not clinically relevant (range: −0.005 to 0.007 quality-adjusted life-years). Strategy 1 was cost-effective compared to all other strategies [highest incremental net monetary benefit (iNMB)]. However, there was a large overlap in credible intervals, especially between strategies 1 and 2. Scenario analyses showed that 50% reduction of drug prices would result in the highest iNMB for strategy 2. A biomarker only becomes cost-effective when it is inexpensive and has a sensitivity and specificity of at least 84%. Conclusion: Because our study showed a comparable iNMB for tapering in four or five steps (including discontinuation), we recommend a choice between these strategies, based on shared decision making. |
| Databáze: | OpenAIRE |
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