Details

Autor(en) / Beteiligte

• Tran‐Duy, An
• Ghiti Moghadam, Marjan
• Oude Voshaar, Martijn A. H.
• Vonkeman, Harald E.
• Boonen, Annelies
• Clarke, Philip
• McColl, Geoff
• Klooster, Peter M.
• Zijlstra, T. R.
• Lems, Willem F.
• Riyazi, N.
• Griep, E. N.
• Hazes, J. M. W.
• Landewé, Robert
• Bernelot Moens, Hein J.
• Riel, Piet L. C. M.
• Laar, Mart A. F. J.
• Jansen, T. L.

Titel

An Economic Evaluation of Stopping Versus Continuing Tumor Necrosis Factor Inhibitor Treatment in Rheumatoid Arthritis Patients With Disease Remission or Low Disease Activity

Ist Teil von

• Arthritis & rheumatology (Hoboken, N.J.), 2018-10, Vol.70 (10), p.1557-1564

Ort / Verlag

Atlanta: Wiley Subscription Services, Inc

Erscheinungsjahr

2018

Link zum Volltext

Quelle

Wiley Online Library

Beschreibungen/Notizen

• Objective To evaluate, from a societal perspective, the incremental cost‐effectiveness of withdrawing tumor necrosis factor inhibitor (TNFi) treatment compared to continuation of these drugs within a 1‐year, randomized trial among rheumatoid arthritis patients with longstanding, stable disease activity or remission. Methods Data were collected from a pragmatic, open‐label trial. Cost‐utility analysis was performed using the nonparametric bootstrapping method, and a cost‐effectiveness acceptability curve was constructed using the net‐monetary benefit framework, where a willingness‐to‐accept threshold (WTA) was defined as the minimal cost saved that a patient accepted for each quality‐adjusted life year (QALY) lost. Results A total of 531 patients were randomized to the stop group and 286 patients to the continuation group. Withdrawal of TNFi treatment resulted in a >60% reduction of the total drug cost, but led to an increase of ∼30% in other health care expenditures. Compared to continuation, stopping TNFi resulted in a mean yearly cost saving of €7,133 (95% confidence interval [95% CI] €6,071, €8,234]) and was associated with a mean loss of QALYs of 0.02 (95% CI 0.002, 0.040). Mean saved cost per QALY lost and per extra flare incurred in the stop group compared to the continuation group was €368,269 (95% CI €155,132, €1,675,909) and €17,670 (95% CI €13,650, €22,721), respectively. At a WTA of €98,438 per QALY lost, the probability that stopping TNFi treatment is cost‐effective was 100%. Conclusion Although an official WTA is not defined, the mean saved cost of €368,269 per QALY lost seems acceptable in The Netherlands, given existing data on willingness to pay.