Draft for SH consultation
EVIDENCE TABLES
4. Identification and diagnosis (REFER 1)
No economic evaluations appraised
4.2 Investigations (INVEST)
No economic evaluations appraised
4.3 Presenting symptoms and signs (PROG)
No economic evaluations appraised
5.1 Patient perceptions and beliefs (PATIENT)
No economic evaluations appraised
5.2 Patient education (EDU)
No economic evaluations appraised
6.1 The multidisciplinary team (MULTI)
No economic evaluations appraised
6.2 Physiotherapy (PHYSIO)
Rheumatoid Arthritis guideline (August 2008)
Draft for SH consultation
Bibliographic reference
Economic study type
Population, country & perspective
Intervention Comparison(s)
Source of effectiveness data
Method of eliciting health valuations (if applicable)
Cost components included
Currency and cost year
Results - cost per patient per alternative
Results - effectiveness per patient per alternative
Results - incremental cost-effectiveness
Results - uncertainty
Time horizon & discount rate
Source of funding
Comments
Overall study quality (++,+,-)
Evidence Table
PHYSIO
Van Den Hout, W. De Jong, Z. Munneke, M. Hazes, J. Breedveld, F. Vliet Vlieland, T. Cost-Utility and Cost-Effectiveness Analyses
of a Long-Term, High-Intensity Exercise Program Compared With Conventional Physical Therapy in Patients with Rheumatoid Arthritis.
Arthritis & Rheumatism 2005 53(1) 39-47
Ref ID: 11
Cost-utility analysis
RAPIT study – multicenter, single-blinded randomised controlled trial. 2 universities and 2 non-university outpatient rheumatology
clinics in the Netherlands. A societal perspective was taken for this analysis
1. Rheumatoid Arthritis Patients in Training (RAPIT) Intensive Exercise Program
Long term, high-intensity weight-bearing exercise classes aimed at maintaining and improving physical ability. Group exercise classes
for 2 years, 2 75-minute sessions a week. Consisted of warming up, bicycle training, exercise circuit, sport or game and cooling down.
Classes could be adapted to individual needs.
2. Usual Care
Patients received usual care, consisting of individual physical therapy, only if this was regarded necessary by the attending physician.
Single-blind randomised controlled trial
RAQoL questionnaire, RAND-36 questionnaire (mapped to SF-6D)
Costs included are those of the health service (hospital and community) and the patient.
Euros 2004
The average annual medical cost per patient for the RAPIT program was 2,115euros, compared to 1683euros for usual care.
The RAPIT group showed no significant different in QALY using SF-6D, and using EQ-5D and VAS the usual care program showed
greater QALY gains.
The study reports ICERs for total societal cost, concluding that using EQ-5D and VAS, the UC has better cost-utility, and using the SF6D the ICER is 67,000 euros per QALY, but with no significant difference in the net benefit.
Double-sided bootstrapping was performed, but no PSA. MACTAR was the most sensitive variable found
2 years – no discounting
Unclear – Leiden University Medical Centre
This paper does not provided convincing cost-effectiveness evidence in support of a high intensity exercise program. Being a Dutch
study, the conclusions are limited to their applicability in a UK context, and the study does not allow for long term health benefits to be
accrued from the RAPIT classes.
+
6.3 Occupational therapy (OCCU)
Bibliographic reference
Evidence Table
OCCU
Li, L. Maetzel, A. Davis, A. Lineker, S. Bombardier, C. Coyte, P. Primary Therapist Model for Patients Referred for Rheumatoid
Arthritis Rehabilitation: A Cost-Effectiveness Analysis. Arthritis & Rheumatism 2006 55(3) 402-410
Ref ID: 33
Rheumatoid Arthritis guideline (August 2008)
Draft for SH consultation
Economic study type
Population, country & perspective
Intervention Comparison(s)
Source of effectiveness data
Method of eliciting health valuations (if applicable)
Cost components included
Currency and cost year
Results - cost per patient per alternative
Results - effectiveness per patient per alternative
Results - incremental cost-effectiveness
Results - uncertainty
Time horizon & discount rate
Source of funding
Comments
Overall study quality (++,+,-)
Bibliographic reference
Economic study type
Population, country & perspective
Intervention Comparison(s)
Cost-utility analysis
173 patients with RA in Ontario, Canada. The analysis was performed from a societal perspective
1. Primary Therapist Model (PTM)
The PTM was instituted by the Arthritis Society of Ontario. Physical Therapists (PTs) and Occupational Therapists (OTs) function as
case managers and multi-skilled rehabilitation professionals. Primary therapists may consult their respective PT or OT colleague,
rather that transferring the patient for completion of the treatment. Services are provided at the patient’s home or in clinics that are set
up in partnership with local rheumatologists and primary care physicians. Disease-specific, cross-disciplinary training is continuously
being offered by The Arthritis Society to all PTM therapists.
2. Traditional Therapy Model (TTM)
Generalists rehabilitation professionals provide discipline-specific arthritis care or in rehabilitation clinics or at the patient’s home
RCT (Li et al 2006)
EQ-5D
Direct and indirect costs were recorded, using the Health Resource Utilization (HRU) questionnaire.
Canadian Dollars 2002 (discount rate 3%)
Over 6 months, health care resources and indirect costs led to a total amount of $6,848 for PTM and $6,266 for TTM. Incremental
annual societal costs were $1,163. This difference is not significantly different however.
PTM EQ-5D utility values rose from 0.46 to 0.56 from baseline to 6months. TTM EQ-5D utility value dropped from 0.57 to 0.53. The
PTM group had a QALY gain of 0.068 whilst the TTM group had a negative QALY of -0.017. The incremental mean QALY gain from
baseline between the two groups was 0.085. This difference is not significantly different however.
Estimated ICER of $13,700 per QALY gained. However, further analysis using adjusted QALY (age, sex, disease duration) saw a
substantial increase in the ICER to $96,000
SA was performed on the cost valuation for lost productivity, and a regression analysis was conducted for QALYS by adjusting for
baseline measures where there was a statistically significant difference. (this is mainly because the TTM group was younger, had more
women and shorter DD). Adjusting the QALYs resulted in PTM becoming a much less cost-effective option.
6 months – no discounting was performed due to short duration of study
Canadian Institutes of Health Research and Canadian Arthritis Network
The study is well designed and constructed, but the differences in service delivery, health care professionals roles, treatment costs and
health systems means that the results are limited in terms of its applicability in the UK. The analysis suggests that PTM has the
potential to be an alternative to traditional OT and PT roles, and it may be cost-effective. Long-term analysis is required for an
understanding of the long-term costs and benefits of managing RA. A feasibility study would perhaps aid decision-makers in
determining whether this model could be implemented in the UK
+
Evidence Table
PHYSIO/OCCU
van den Hout, W. B., P. D. de Buck, and T. P. Vliet Vlieland. "Cost-utility analysis of a multidisciplinary job retention vocational
rehabilitation program in patients with chronic arthritis at risk of job loss." Arthritis & Rheumatism 57.5 (2007): 778-86.
Ref ID: 2
Cost-utility analysis
RCT in which a multidisciplinary job retention vocational rehabilitation program was compared with normal outpatient care initiated by
the treating rheumatologist. Leiden University Medical Center, The Netherlands. The analysis was from a societal perspective.
1. Job Retention Vocational Rehabilitation Program
Rheumatoid Arthritis guideline (August 2008)
Draft for SH consultation
Source of effectiveness data
Method of eliciting health valuations (if applicable)
Cost components included
Currency and cost year
Results - cost per patient per alternative
Results - effectiveness per patient per alternative
Results - incremental cost-effectiveness
Results - uncertainty
Time horizon & discount rate
Source of funding
Comments
Overall study quality (++,+,-)
Multidisciplinary team comprising a coordinator, rheumatologist, social work, physical therapist, occupational therapist, psychologist and
an occupational physician. A basic, systematic assessment was performed, followed by education, vocational counselling, guidance
and medical or non-medical treatment. Patients made at least 2 visits to the hospital in connection with the job retention vocational
rehabilitation program.
2. Usual Care Group
Treated and referred to other health professionals for their work-related problem if this was regarded as necessary by their
rheumatologist. The referring rheumatologists were informed of the treatment allocation. In both groups, physicians had free choice
with respect to their medical prescriptions and other treatment strategies.
Multicenter, randomised controlled trial
EQ-5D and the RAND-36 questionnaire (mapped to SF-6D)
Costs included are those of the health service (hospital and community), the patient and the societal perspective through productivity
costs.
Euros 2005
Average two year costs per patient:
No statistically significant differences in non-program health care costs or non-health care costs were found.
No statistically significant differences in QALYs were found between the 2 groups on any of the utility measures. The utility measures
did show an improvement over time in both randomised groups, which was surprising in a way as RA is a progressive disease. The
multidisciplinary job retention program provided greater improvement of fatigue levels and mental health, but did not reduce job loss.
No effect on health care consumption or QALYs was observed. Cost variability means that determining if the program reduces or
increases costs
No formal sensitivity analysis is performed.
2 years (Costs were not discounted; it is unclear if QALYs were).
Dutch Medical Science Organization
There were not significant differences in both the costs and effectiveness between the programs and so conclusions on its costeffectiveness cannot be made. A formal sensitivity analysis may have helped investigate and to flag the key variables in the model.
The applicability of this Dutch Care Program may be limited, this is noted in the analysis
+
6.4 Podiatry (POD)
No economic evaluations appraised
7.1 Symptom control (ANALG, NSAIDs)
ANALG
Rheumatoid Arthritis guideline (August 2008)
Draft for SH consultation
No economic evaluations appraised
NSAIDS
COX-2 Inhibitors - taken from the Brown HTA Report and the NICE TA Cox-2 Assessment Report
Study
Sponsor
Country
Comparators
Patients
Svarvar 2000
Pfizer
Norway
Celecoxib vs NSAID
Chancellor 2001
Pharmacia
Switzerland
You 2002
Pfizer and
Pharmacia
University
NIH grants
from
Pharmacia
Pfizer and
Pharmacia
CCOHTA
El-Serag 2002
Spiegel 2003
Zabinski 2001
Maetzel 2003
Fendrick 2002
Brown 2006
SmithKline
Beecham
NCCHTA
Non selective NSAIDs
McCabe 1998
SmithKline
Model used
ICER
Conclusions
OA and RA
Time
horizon
1 year
ACCES DA
model
Celecoxib dominates
Celecoxib vs NSAID
Arthritis
6 months
Hong Kong
Celecoxib vs NSAID
OA and RA
6 months
DA with Monte
Carlo
DA
Per GI event
averted, per
LYG
Per adverse
event
Expected Cost
USA
USA
Celecoxib vs NSAID
Celecoxib or rofecoxib
vs naproxen
Cox-I users
OA and RA
1 year
Lifetime
DA
DA
Per UGI event
Per QALY
Canada
Celecoxib vs NSAID
OA and RA
6 months
DA
Expected cost
Canada
Naproxen vs
Rofecoxib, Diclofenac
vs Celecoxib,
Ibuprofen vs
celecoxib.
OA and RA
5 years
Markov
Per QALY
Cox-2 are dominant in high-risk patients
Rofecoxib and celecoxib are cost-effective in
high-risk patients (US$55k)
Average risk US$275k
Celecoxib has lower expected cost than
NSAID+H2RA, NSAID+misoprostol, NSAID+PPI
but more costly than NSAID
Average risk
Celecoxib and Rofecoxib unlikely to be costeffective (Can$271k and Can$125k respectively)
High risk
Rofecoxib dominates naproxen +PPI
Celecoxib dominates ibuprofen +PPI
Long term
NSAID
users
1 year
Markov
Per
symptomatic
ulcer avoided
US$32k per symptomatic ulcer avoided
OA and RA
6 months
Probabilistic
DA model
Per ulcer
avoided, per
serious GI
event avoided
and per LYG
Mean ICER: £301 per endoscopic ulcer avoided
£22,843 per serious GI event averted
£12742 per LYG
OA and RA
3 months
Decision tree
Per LYG
Co prescription after minor AE: £2517per LYG
US
UK
UK
High risk are same as
above + PPI
Cox-2 vs generic
NSAID switched to
safer NSAID after AE
Cox-2 vs safer
NSAIDs as first line
Cox-2 vs Cox-I, along
with principal GPA
strategies (PPI, H2RA
and misoprostol)
Nabumetone,
Rheumatoid Arthritis guideline (August 2008)
Celecoxib dominates
Celecoxib has lowest expected cost
US$57k per complicated ulcer avoided
Draft for SH consultation
Beecham UK
Ibuprofen
Switching after minor AE: £1880 per LYG
7.2 Glucocorticoids (CORTICO)
Bibliographic reference
Economic study type
Population, country & perspective
Intervention Comparison(s)
Evidence Table
CORTICO
S.-C. Bae, M. Corzillius, K. M. Kuntz and M. H. Liang. Cost-effectiveness of low dose corticosteroids versus non-steroidal anti-inflammatory
drugs and COX-2 specific inhibitors
Cost-utility analysis
US Study
In the base case two treatment strategies were compared to assess costs and health effects of corticosteroids compared with NSAIDs:
(1) treat patients with any DMARDs (antimalarial, sulphasalazine, D-penicillamine, methotrexate, gold compound, azathioprine, leflunomide)
and corticosteroids;
(2) treat patients with any DMARDs and NSAIDs.
NSAIDS have a number of side effects so NSAIDs alongside co-treatments to prevent GI toxicity were also analysed and compared against
corticosteroids.
Source of effectiveness data
Method of eliciting health valuations (if applicable)
Cost components included
Currency and cost year
Results - cost per patient per alternative
Results - effectiveness per patient per alternative
Results - incremental cost-effectiveness
Results - uncertainty
Time horizon & discount rate
Source of funding
Comments
Overall study quality (++,+,-)
As well as this corticosteroids were analysed against the comparator of Cox-2 specific inhibitors.
Published evidence
TTO or SG published utility adjustments
Direct costs taken from published literature
1999 US Dollars
In the base case analysis the cost of corticosteroids was $43 800 compared with $44 900 for NSAIDs
the health outcome of corticosteroids was 11.67 QALYs compared with 11.46 QALYs for NSAIDs
Both available COX-2 specific inhibitors are associated with higher costs ($63 000) and have better outcomes than corticosteroids (11.81
QALYs), which result in an incremental C/E ratio of 132 880 ($/QALY). Therefore corticosteroids are more cost-effective than the COX-2
inhibitors as well. The sensitivity analysis varying cost showed that COX-2 inhibitors were superior to corticosteroids when the cost was less
than $707.
When misoprostol prophylaxis was used with NSAIDs to prevent GI toxicity it was more costly ($56 000) and less effective (11.62 QALYs)
than corticosteroids; corticosteroids were superior to NSAIDs. If omeprazole was given with NSAIDs, it was more costly and yielded a better
health outcome than corticosteroids; its cost and health outcome were $68 000 and 11.77 QALYs. The incremental C/E ratio was 231 895
$/QALY.
Lifetime horizon, 3% discount rate
Korean Ministry of Health
Study was based in US hence resources used and their associated costs could be very different in the US.
++
Rheumatoid Arthritis guideline (August 2008)
Draft for SH consultation
Bibliographic reference
Economic study type
Population, country & perspective
Intervention Comparison(s)
Source of effectiveness data
Method of eliciting health valuations (if applicable)
Cost components included
Currency and cost year
Results - cost per patient per alternative
Results - effectiveness per patient per alternative
Results - incremental cost-effectiveness
Results - uncertainty
Time horizon & discount rate
Source of funding
Comments
Overall study quality (++,+,-)
Evidence Table
CORTICO
Verhoeven,A.C.; Bibo,J.C.; Boers,M.; Engel,G.L.; Van Der,Linden S. Cost-effectiveness and cost-utility of combination therapy in early
rheumatoid arthritis: randomized comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine
alone. COBRA Trial Group. British Journal of Rheumatology.37(10):1102-9 1998
Cost-utility analysis
Multicentre RCT of patients with early RA (ACR criteria and a mean disease duration of 4 months). 9 centres in The Netherlands and one
in Belgium. Costs were from a societal perspective, and effectiveness from the patients perspective
Strategies for treatment of early RA. Strategy A: A combination therapy regimen of step-down prednisolone, methotrexate and
sulphasalazine (COBRA). Strategy B: Sulphasalazine monotherapy
COBRA Trial 1993-1996
The Maastricht Utility Measurement Questionnaire
Direct Costs - cost of intervention, cost of non-protocol drugs, other costs of out-patient care, costs of in-patient care, direct non-medical
costs
Dutch Guilders converted to US dollars ($) at 1994 PPP rate of 2.143:1
Mean total costs per patient were $5519 for the combined treatment and $6511 for sulphasalazine monotherapy (P=0.37)
Clinical, radiographic and functional outcomes significantly favoured combined treatment at week 28 (radiography also at week 56). Utility
scores also favoured combined treatment (difference of 0.02 gained QALY)
Combined treatment is the dominant therapeutic option due to enhanced efficacy at no higher cost
Sensitivity analysis performed strongly support combined treatment as the dominant option
56weeks, due to a time horizon of just over 1 year, no discounting of future costs of benefits was deemed necessary
COBRA - Grant 92-0245 Ontwikkelingsgeneeskunde, Ziekenfrondsraad
The results are convincing, but because the trial and costs are taken from The Netherlands and Belgium, they should be treated with
caution due to differences in costs and health systems
++
7.3 Disease modifying and biological drugs: when to introduce, and optimal sequencing
introducing DMARDS (DMARD)
Bibliographic reference
Economic study type
Population, country & perspective
Evidence Table
DMARD
Grigor C, Capell H, Stirling A, McMahon AD, Lock P, Vallance R, Kincaid W, Porter D. Effect of a treatment strategy of tight control for
rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial. ACP J Club. 2004 Nov-Dec;141(3):70.
Ref ID:
Cost-effectiveness analysis, Outcome: Disease Activity Score (DAS)
RCT of patients with RA (DAS>2.5) for less than 5 years from two teaching hospitals in Glasgow, UK. Patients who had previously
Rheumatoid Arthritis guideline (August 2008)
Draft for SH consultation
Intervention Comparison(s)
Source of effectiveness data
Method of eliciting health valuations (if applicable)
Cost components included
Currency and cost year
Results - cost per patient per alternative
Results - effectiveness per patient per alternative
Results - incremental cost-effectiveness
Results - uncertainty
Time horizon & discount rate
Source of funding
Comments
Overall study quality (++,+,-)
received combination DMARD treatment were excluded. Economic analysis was conducted from the perspective of the NHS and the
patient
Strategies for treatment of early RA. Strategy A: Intensive DMARD (TICORA regimen with monthly assessment and additional DMARDs if
persistent disease). Strategy B: Routine DMARD care (patients reviewed every 3 months with no formal composite measure of disease
activity). In both cases, persistent disease activity is met with an identical therapy protocol but with strategy A the step up is much quicker
after formal monitoring.
To examine if the intensive outpatient DMARD (TICORA) strategy for RA is cost effective in terms of improving health outcomes.
Single-blind randomised controlled trial
HAQ
Costs included are those of the health service (hospital and community) and the patient.
Pounds(£), 2000
Intensive strategy is no more costly than comparator (TICORA total cost £3475 per patient, routine regimen £4127 per patient)
Intensive strategy substantially improves disease activity, radiographic disease progression, physical function and quality of life
None, intensive strategy is dominant (no more costly and more effective)
SA performed on costs concluded that intensive group was dominant even after a 20% reduction or 50% increase
18months, no discounting
Funded by the Chief Scientist's Office, Scottish Executive
The study is not explicitly concerned with early RA, as inclusion criteria =<5 years and mean disease duration is 19months.
-
Rheumatoid Arthritis guideline (August 2008)
Draft for SH consultation
Bibliographic reference
Economic study type
Population, country & perspective
Intervention Comparison(s)
Source of effectiveness data
Method of eliciting health valuations (if applicable)
Cost components included
Currency and cost year
Results - cost per patient per alternative
Results - effectiveness per patient per alternative
Results - incremental cost-effectiveness
Results - uncertainty
Time horizon & discount rate
Source of funding
Comments
Overall study quality (++,+,-)
Evidence Table
DMARD
Verhoeven,A.C.; Bibo,J.C.; Boers,M.; Engel,G.L.; Van Der,Linden S. Cost-effectiveness and cost-utility of combination therapy in early
rheumatoid arthritis: randomized comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine
alone. COBRA Trial Group. British Journal of Rheumatology.37(10):1102-9 1998
Ref ID: 153
Cost-utility analysis
Multicentre RCT of patients with early RA (ACR criteria and a mean disease duration of 4 months). 9 centres in The Netherlands and one
in Belgium. Costs were from a societal perspective, and effectiveness from the patients perspective
Strategies for treatment of early RA. Strategy A: A combination therapy regimen of step-down prednisolone, methotrexate and
sulphasalazine (COBRA). Strategy B: Sulphasalazine monotherapy
COBRA Trial 1993-1996
The Maastricht Utility Measurement Questionnaire
Direct Costs - cost of intervention, cost of non-protocol drugs, other costs of out-patient care, costs of in-patient care, direct non-medical
costs
Dutch Guilders converted to US dollars ($) at 1994 PPP rate of 2.143:1
Mean total costs per patient were $5519 for the combined treatment and $6511 for sulphasalazine monotherapy (P=0.37)
Clinical, radiographic and functional outcomes significantly favoured combined treatment at week 28 (radiography also at week 56). Utility
scores also favoured combined treatment (difference of 0.02 gained QALY)
Combined treatment is the dominant therapeutic option due to enhanced efficacy at no higher cost
Sensitivity analysis performed strongly support combined treatment as the dominant option
56weeks, due to a time horizon of just over 1 year, no discounting of future costs of benefits was deemed necessary
COBRA - Grant 92-0245 Ontwikkelingsgeneeskunde, Ziekenfrondsraad
The results are convincing, but because the trial and costs are taken from The Netherlands and Belgium, they should be treated with
caution due to differences in costs and health systems
+
Rheumatoid Arthritis guideline (August 2008)
Draft for SH consultation
Bibliographic reference
Economic study type
Population, country & perspective
Intervention Comparison(s)
Source of effectiveness data
Method of eliciting health valuations (if applicable)
Cost components included
Currency and cost year
Results - cost per patient per alternative
Results - effectiveness per patient per alternative
Results - incremental cost-effectiveness
Results - uncertainty
Time horizon & discount rate
Source of funding
Comments
Overall study quality (++,+,-)
Evidence Table
DMARD
Korthals-de B, I, Van TM, Boers M et al. Indirect and total costs of early rheumatoid arthritis: a randomized comparison of combined stepdown prednisolone, methotrexate, and sulfasalazine with sulfasalazine alone. Journal of Rheumatology 31(9):1709-16, 2004 September.
Ref ID: 59
Cost-effectiveness Analysis. Outcomes: pooled index, radiographic damage and utilities
Multicentre RCT of patients with early RA (ACR criteria and a mean disease duration of 4 months). 9 centres in The Netherlands and one
in Belgium. Costs were from a societal perspective, and effectiveness from the patients perspective
Strategies for treatment of early RA. Strategy A: A combination therapy regimen of step-down prednisolone, methotrexate and
sulphasalazine (COBRA). Strategy B: Sulphasalazine monotherapy
COBRA Trial
The Maastricht Utility Measurement Questionnaire
Direct costs (attributable to the treatment regimen, healthcare, hospitalisation) and Indirect cots (production losses due to RA for both paid
and unpaid labour (using human capital method and friction cost method)
Dutch Guilders converted to US dollars ($) at 1994 PPP rate of 2.143:1
Period 0-28 weeks: Total costs COBRA $5,931, SSZ $7,853
Period 29-56 weeks: Total costs COBRA $4,330, SSZ $4,935
Period 0-56 weeks: Total costs COBRA $10,262, SSZ $12,788
At 56 weeks: Mean improvement (rating scale) 0.18 COBRA and 0.16 SSZ, using standard gamble 0.07 in both.
ICER (rating scale) $-385 cost per QALY (COBRA is a dominant strategy)
ICER (standard gamble) $-1,134 cost per QALY( COBRA is a dominant strategy)
SA focused on indirect costs, but use of different resources in calculating difference indirect costs did not result in any change. The limiting
of the effect of long absenteeism to a fixed maximum caused indirect costs to be greater in the COBRA group.
56 weeks - therefore no discounting
COBRA trial Onnvikkelingsgeneeskande, Ziekenfondsraad.
The results are convincing, but because the trial and costs are taken from The Netherlands and Belgium, they should be treated with
caution due to differences in costs and health systems
+
Rheumatoid Arthritis guideline (August 2008)
Health Economic Evidence Tables
optimal sequencing of DMARDs (DRUG1)
Table 1 Summary of published economic analyses
Study
Spalding et al (2006)
Chen et al (2006)
Disease
Duration
(yrs)
3 months
Sponsor
County
TNF inhibitor(s) considered
Form of economic
analysis
Model used
Time horizon
Astellas Pharma, US
USA
Cost utility
Markov
Lifetime
Various
(even
within
“early” RA)
NHS HTA programme
UK
Adalimumab, Etanercept, infliximab
+ methotrexate, adalimumab +
methotrexate
Adalimumab, Etanercept, infliximab
+ methotrexate, adalimumab +
methotrexate, Etanercept+
methotrexate
Cost utility
Patient level
simulation
lifetime
Rheumatoid Arthritis guideline (August 2008)
Health Economic Evidence Tables
Table 2 Summary of published ICERs for TNF inhibitors*
Drug
Adalimumab
Etanercept
Infliximab
Comparator
DMARD sequence
Study
Chen
Date
2006
Time horizon
Lifetime
Methotrexate
Spalding
2006
Lifetime
DMARD sequence
Chen
2006
Lifetime
Methotrexate
DMARD sequence
Methotrexate
Spalding
Chen
Spalding
2006
2006
2006
Lifetime
Lifetime
Lifetime
ICER
Adalimumab (no MTX)
Adalimumab (with MTX)
(Third line (early RA data))
Adalimumab (no MTX)
Adalimumab (with MTX)
(First line (Early RA data))
Adalimumab (no MTX)
Adalimumab (with MTX)
Etanercept (no MTX)
Etanercept (with MTX)
(Third line (early RA data))
Etanercept (no MTX)
Etanercept (with MTX)
(First line (Early RA data))
Etanercept (no MTX)
Infliximab (with MTX)
(Third line (early RA data))
Infliximab (with MTX)
(First line (Early RA data))
Infliximab (with MTX)
7.4 Disease modifying and biological drugs: relative merits (DRUG 3, ANAKIN)
DRUG 3
No economic evaluations appraised
ANAKIN
No economic evaluations appraised
Rheumatoid Arthritis guideline (August 2008)
£35k per QALY
£30k per QALY
£53k per QALY
£170k per QALY
$64k per QALY
$195k per QALY
£30k per QALY
£28k per QALY
£49k per QALY
£78k per QALY
$90k per QALY
£30k per QALY
£650k per QALY
$410k per QALY
Health Economic Evidence Tables
7.5 Disease modifying and biological drugs: when to withdraw them (DRUG2)
No economic evaluations appraised
8.1 Monitoring disease (MONIT)
No economic evaluations appraised
8.2 Content and frequency of review (REVIEW)
No economic evaluations appraised
8.3 Timing and referral for surgery (REFER2)
No economic evaluations appraised
9.1 Diet (DIET)
No economic evaluations appraised
9.2 Complimentary and alternative interventions (CAM)
No economic evaluations appraised
Rheumatoid Arthritis guideline (August 2008)