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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Health+Technol+Assess
2016 ; 20
(35
): 1-610
Nephropedia Template TP
gab.com Text
Twit Text FOAVip
Twit Text #
English Wikipedia
Adalimumab, etanercept, infliximab, certolizumab pegol, golimumab, tocilizumab
and abatacept for the treatment of rheumatoid arthritis not previously treated
with disease-modifying antirheumatic drugs and after the failure of conventional
disease-modifying antirheumatic drugs only: systematic review and economic
evaluation
#MMPMID27140438
Stevenson M
; Archer R
; Tosh J
; Simpson E
; Everson-Hock E
; Stevens J
; Hernandez-Alava M
; Paisley S
; Dickinson K
; Scott D
; Young A
; Wailoo A
Health Technol Assess
2016[Apr]; 20
(35
): 1-610
PMID27140438
show ga
OBJECTIVES: Rheumatoid arthritis (RA) is a chronic inflammatory disease
associated with increasing disability, reduced quality of life and substantial
costs (as a result of both intervention acquisition and hospitalisation). The
objective was to assess the clinical effectiveness and cost-effectiveness of
seven biologic disease-modifying antirheumatic drugs (bDMARDs) compared with each
other and conventional disease-modifying antirheumatic drugs (cDMARDs). The
decision problem was divided into those patients who were cDMARD naive and those
who were cDMARD experienced; whether a patient had severe or moderate to severe
disease; and whether or not an individual could tolerate methotrexate (MTX). DATA
SOURCES: The following databases were searched: MEDLINE from 1948 to July 2013;
EMBASE from 1980 to July 2013; Cochrane Database of Systematic Reviews from 1996
to May 2013; Cochrane Central Register of Controlled Trials from 1898 to May
2013; Health Technology Assessment Database from 1995 to May 2013; Database of
Abstracts of Reviews of Effects from 1995 to May 2013; Cumulative Index to
Nursing and Allied Health Literature from 1982 to April 2013; and TOXLINE from
1840 to July 2013. Studies were eligible for inclusion if they evaluated the
impact of a bDMARD used within licensed indications on an outcome of interest
compared against an appropriate comparator in one of the stated population
subgroups within a randomised controlled trial (RCT). Outcomes of interest
included American College of Rheumatology (ACR) scores and European League
Against Rheumatism (EULAR) response. Interrogation of Early Rheumatoid Arthritis
Study (ERAS) data was undertaken to assess the Health Assessment Questionnaire
(HAQ) progression while on cDMARDs. METHODS: Network meta-analyses (NMAs) were
undertaken for patients who were cDMARD naive and for those who were cDMARD
experienced. These were undertaken separately for EULAR and ACR data. Sensitivity
analyses were undertaken to explore the impact of including RCTs with a small
proportion of bDMARD experienced patients and where MTX exposure was deemed
insufficient. A mathematical model was constructed to simulate the experiences of
hypothetical patients. The model was based on EULAR response as this is commonly
used in clinical practice in England. Observational databases, published
literature and NMA results were used to populate the model. The outcome measure
was cost per quality-adjusted life-year (QALY) gained. RESULTS: Sixty RCTs met
the review inclusion criteria for clinical effectiveness, 38 of these trials
provided ACR and/or EULAR response data for the NMA. Fourteen additional trials
contributed data to sensitivity analyses. There was uncertainty in the relative
effectiveness of the interventions. It was not clear whether or not formal
ranking of interventions would result in clinically meaningful differences.
Results from the analysis of ERAS data indicated that historical assumptions
regarding HAQ progression had been pessimistic. The typical incremental cost per
QALY of bDMARDs compared with cDMARDs alone for those with severe RA is
>?£40,000. This increases for those who cannot tolerate MTX (£50,000) and is
>?£60,000 per QALY when bDMARDs were used prior to cDMARDs. Values for
individuals with moderate to severe RA were higher than those with severe RA.
Results produced using EULAR and ACR data were similar. The key parameter that
affected the results is the assumed HAQ progression while on cDMARDs. When
historic assumptions were used typical incremental cost per QALY values fell to
£38,000 for those with severe disease who could tolerate MTX. CONCLUSIONS:
bDMARDs appear to have cost per QALY values greater than the thresholds stated by
the National Institute for Health and Care Excellence for interventions to be
cost-effective. Future research priorities include: the evaluation of the
long-term HAQ trajectory while on cDMARDs; the relationship between HAQ direct
medical costs; and whether or not bDMARDs could be stopped once a patient has
achieved a stated target (e.g. remission). STUDY REGISTRATION: This study is
registered as PROSPERO CRD42012003386. FUNDING: The National Institute for Health
Research Health Technology Assessment programme.
|*Cost-Benefit Analysis
[MESH]
|Abatacept/therapeutic use
[MESH]
|Adalimumab/therapeutic use
[MESH]
|Antibodies, Monoclonal, Humanized/therapeutic use
[MESH]
free
free
free
