Cost-Effectiveness of Sequential Therapy with Tumor Necrosis Factor Antagonists in Early Rheumatoid Arthritis

2009 ◽  
Vol 36 (1) ◽  
pp. 16-26 ◽  
Author(s):  
ANDREW DAVIES ◽  
MARY A. CIFALDI ◽  
OSCAR G. SEGURADO ◽  
MICHAEL H. WEISMAN
Keyword(s):  
Rheumatoid Arthritis ◽  
Cost Effectiveness ◽  
Tumor Necrosis ◽  
Cost Effective ◽  
Tnf Antagonists ◽  
Productivity Losses ◽  
Line Therapy ◽  
Tnf Antagonist ◽  
The Cost ◽  
Necrosis Factor

ObjectiveTo estimate the comparative lifetime cost-effectiveness of sequenced therapy with tumor necrosis factor (TNF) antagonists as the initial therapeutic intervention for patients with early rheumatoid arthritis (RA).MethodsBecause patients with RA switch regimens many times throughout the course of disease, sequenced therapeutic interventions were modeled, continuing until the last effective agent failed or death occurred. The model used published clinical outcomes from short-term, randomized controlled trials. Direct treatment costs and costs of lost productivity were modeled for each of 5 alternative treatment sequences. Incremental cost-effectiveness ratios are expressed as quality-adjusted lifeyears (QALY) gained.ResultsTreatment sequences that included TNF antagonists produced a greater number of QALY than conventional disease modifying antirheumatic drug regimens alone. The cost-effectiveness of sequenced therapy initiated with adalimumab plus methotrexate (MTX) extendedly dominated both infliximab-plus-MTX–initiated and etanercept sequences. The cost of adalimumab plus MTX per QALY was US $47,157 excluding productivity losses, and $19,663 including productivity losses. A supplementary sequence that incorporated adalimumab-plus-MTX–initiated first-line therapy followed by another TNF antagonist as second-line therapy was modeled; this sequence resulted in additional QALY gained and extendedly dominated all single-TNF strategies.ConclusionOf the 3 single-TNF antagonist sequences, the adalimumab-plus-MTX–initiated sequence was cost-effective in producing the greatest number of QALY. Multiple TNF strategies, such as the supplementary sequence modeled in this analysis, may be cost-effective in producing even greater health gain.

scholarly journals Cost-Effectiveness Analysis of Biopharmaceuticals for Treating Rheumatoid Arthritis: Infliximab, Adalimumab, and Etanercept

2021 ◽  
Vol 2021 ◽  
pp. 1-12
Author(s):  
Ahmad Gholami ◽  
Jassem Azizpoor ◽  
Elham Aflaki ◽  
Mehdi Rezaee ◽  
Khosro Keshavarz
Keyword(s):  
Rheumatoid Arthritis ◽  
Sensitivity Analysis ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
The Other ◽  
Cost Data ◽  
Fars Province ◽  
Study Results ◽  
The Mean ◽  
The Cost

Introduction. Rheumatoid arthritis (RA) is a chronic progressive inflammatory disease that causes joint destruction. The condition imposes a significant economic burden on patients and societies. The present study is aimed at evaluating the cost-effectiveness of Infliximab, Adalimumab, and Etanercept in treating rheumatoid arthritis in Iran. Methods. This is a cost-effectiveness study of economic evaluation in which the Markov model was used. The study was carried out on 154 patients with rheumatoid arthritis in Fars province taking Infliximab, Adalimumab, and Etanercept. The patients were selected through sampling. In this study, the cost data were collected from a community perspective, and the outcomes were the mean reductions in DAS-28 and QALY. The cost data collection form and the EQ-5D questionnaire were also used to collect the required data. The results were presented in the form of an incremental cost-effectiveness ratio, and the sensitivity analysis was used to measure the robustness of the study results. The TreeAge Pro and Excel softwares were used to analyze the collected data. Results. The results showed that the mean costs and the QALY rates in the Infliximab, Adalimumab, and Etanercept arms were $ 79,518.33 and 12.34, $ 91,695.59 and 13.25, and $ 87,440.92 and 11.79, respectively. The one-way sensitivity analysis confirmed the robustness of the results. In addition, the results of the probabilistic sensitivity analysis (PSA) indicated that on the cost-effectiveness acceptability curve, Infliximab was in the acceptance area and below the threshold in 77% of simulations. The scatter plot was in the mentioned area in 81% and 91% of simulations compared with Adalimumab and Etanercept, respectively, implying lower costs and higher effectiveness than the other two alternatives. Therefore, the strategy was more cost-effective. Conclusion. According to the results of this study, Infliximab was more cost-effective than the other two medications. Therefore, it is recommended that physicians use this medication as the priority in treating rheumatoid arthritis. It is also suggested that health policymakers consider the present study results in preparing treatment guidelines for RA.

Effect of Psychological Distress on Continuation of Anti-Tumor Necrosis Factor Therapy in Patients with Rheumatoid Arthritis

2010 ◽  
Vol 37 (10) ◽  
pp. 2021-2024 ◽  
Author(s):  
DEREK L. MATTEY ◽  
PETER T. DAWES ◽  
ANDREW B. HASSELL ◽  
ANN BROWNFIELD ◽  
JONATHAN C. PACKHAM
Keyword(s):  
Rheumatoid Arthritis ◽  
Psychological Distress ◽  
Tumor Necrosis Factor ◽  
Tumor Necrosis ◽  
Depression Scale ◽  
Cox Proportional Hazards ◽  
Smoking History ◽  
Heavy Smoking ◽  
Tnf Antagonists ◽  
Necrosis Factor

Objective.To investigate the relationship of psychological distress and associated factors with continuation of tumor necrosis factor (TNF) antagonist therapy in patients with rheumatoid arthritis (RA).Methods.Patients about to start therapy with TNF antagonists (n = 166) were assessed for psychological distress using the Hospital Anxiety and Depression Scale (HADS). A core set of demographic and clinical variables, including comorbidities from medical records and cigarette smoking history by questionnaire, were recorded at baseline and regular intervals thereafter. Cox proportional hazards regression analysis was used to assess the likelihood of patients discontinuing therapy over a 36-month followup period.Results.The number of years smoked was associated with anxiety (HADS-A; p for trend = 0.008) and general psychological distress (HADS-Total; p for trend = 0.03). In univariate analyses, earlier discontinuation was associated with these variables at baseline: anxiety (HADS-A), depression (HADS-D), abnormal mood (HADS-Total), smoking history (> 30 pack-yrs), years smoked (> 30 yrs), current smoking, high Disease Activity Score 28-joint count (DAS28), poor patient global assessment, and evidence of cardio/cerebrovascular disease (CVD). In multivariate analyses, the strongest predictors of discontinuation were HADS-Total, smoking history (> 30 pack-yrs), DAS28, and evidence of CVD at baseline.Conclusion.Discontinuation of therapy with TNF antagonists is independently associated with psychological distress, heavy smoking, and CVD at baseline.

scholarly journals The Cost-effectiveness of Sequences of Biological Disease-modifying Antirheumatic Drug Treatment in England for Patients with Rheumatoid Arthritis Who Can Tolerate Methotrexate

2017 ◽  
Vol 44 (7) ◽  
pp. 973-980 ◽  
Author(s):  
Matt D. Stevenson ◽  
Allan J. Wailoo ◽  
Jonathan C. Tosh ◽  
Monica Hernandez-Alava ◽  
Laura A. Gibson ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cost Effectiveness ◽  
Health Assessment ◽  
Clinical Effectiveness ◽  
Cost Effective ◽  
Quality Adjusted Life Year ◽  
Antirheumatic Drug ◽  
Disease Modifying ◽  
The Cost ◽  
Disease Modifying Antirheumatic Drug

Objective.To ascertain whether strategies of treatment with a biological disease-modifying antirheumatic drug (bDMARD) are cost-effective in an English setting. Results are presented for those patients with moderate to severe rheumatoid arthritis (RA) and those with severe RA.Methods.An economic model to assess the cost-effectiveness of 7 bDMARD was developed. A systematic literature review and network metaanalysis was undertaken to establish relative clinical effectiveness. The results were used to populate the model, together with estimates of Health Assessment Questionnaire (HAQ) score following European League Against Rheumatism response; annual costs, and utility, per HAQ band; trajectory of HAQ for patients taking bDMARD; and trajectory of HAQ for patients using nonbiologic therapy (NBT). Results were presented as those associated with the strategy with the median cost-effectiveness. Supplementary analyses were undertaken assessing the change in cost-effectiveness when only patients with the most severe prognoses taking NBT were provided with bDMARD treatment. The costs per quality-adjusted life-year (QALY) values were compared with reported thresholds from the UK National Institute for Health and Care Excellence of £20,000 to £30,000 (US$24,700 to US$37,000).Results.In the primary analyses, the cost per QALY of a bDMARD strategy was £41,600 for patients with severe RA and £51,100 for those with moderate to severe RA. Under the supplementary analyses, the cost per QALY fell to £25,300 for those with severe RA and to £28,500 for those with moderate to severe RA.Conclusion.The cost-effectiveness of bDMARD in RA in England is questionable and only meets current accepted levels in subsets of patients with the worst prognoses.

Positive Conversion of Tuberculin Skin Test and Performance of Interferon Release Assay to Detect Hidden Tuberculosis Infection During Anti-Tumor Necrosis Factor Agent Trial

2009 ◽  
Vol 36 (10) ◽  
pp. 2158-2163 ◽  
Author(s):  
JEONG HA PARK ◽  
GA YOUNG SEO ◽  
JIN SOOK LEE ◽  
TAE-HWAN KIM ◽  
DAE-HYUN YOO
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumor Necrosis Factor ◽  
Conversion Rate ◽  
Tumor Necrosis ◽  
Statistical Significance ◽  
False Negative ◽  
Skin Tests ◽  
Tnf Antagonist ◽  
Ifn Γ ◽  
Necrosis Factor

Objectives.To evaluate tuberculin skin tests (TST) and interferon-γ (IFN-γ) assay in the detection of latent tuberculosis (TB) infection during tumor necrosis factor (TNF) antagonist treatment in Korean patients with initial negative TST result.Methods.Eighty-six patients with rheumatic diseases who had received anti-TNF agents for over one year were investigated. Clinical data were obtained from medical records. All patients received followup TST, and IFN-γ assay was performed in 64.Results.The study population consisted of 40 rheumatoid arthritis (RA), 34 ankylosing spondylitis (AS), 9 juvenile rheumatoid arthritis (JRA), and 3 other patients. The TST converted to positive in 28 (32.6%) patients. There was no significant variation between TST conversion rate and all risk factors. Although there was no statistical significance, the odds of the TST conversion rate tended to increase with the duration of TNF antagonist administration. Nine (14.1%) of 64 patients who performed an IFN-γ assay had positive results. Among 28 TST positive conversion cases, 4 patients with AS and 1 with psoriatic arthritis had positive IFN-γ assay results, and one of them developed miliary TB. However, none of the 4 RA patients with positive IFN-γ assay showed TST conversion. There was 68.6% agreement (kappa = 0.29, p = 0.02) between TST and IFN-γ assay results.Conclusion.Serial TST with IFN-γ assay may be useful to identify false-negative response to cases of latent Mycobacterium tuberculosis infection and new TB infections in patients with immune mediated inflammatory diseases during longterm anti-TNF therapy, especially in areas with intermediate TB burden.

Apoptosis as a Mechanism of Action of Tumor Necrosis Factor Antagonists in Rheumatoid Arthritis: Figure 1.

2012 ◽  
Vol 39 (4) ◽  
pp. 679-685 ◽  
Author(s):  
DIMITRIOS MAKRYGIANNAKIS ◽  
ANCA IRINEL CATRINA
Keyword(s):  
Rheumatoid Arthritis ◽  
Tumor Necrosis Factor ◽  
Mechanism Of Action ◽  
Tumor Necrosis ◽  
Unresolved Issue ◽  
Tnf Antagonists ◽  
Tumor Necrosis Factor Antagonists ◽  
Proinflammatory Molecule ◽  
Contradictory Data ◽  
Necrosis Factor

Tumor necrosis factor (TNF) antagonists are drugs developed to block endogenous TNF, an essential proinflammatory molecule with a central role in the pathogenesis of rheumatoid arthritis (RA). Although extensive studies have been performed concerning the mode of action of TNF-blocking agents, there are still many unresolved questions and potential differences between different TNF-blocking drugs. One unresolved issue is to what extent apoptosis is affected by TNF blockade in RA. We provide an overview of studies that have investigated the proapoptotic effect of different anti-TNF drugs in RA, searching for a unified interpretation of somewhat contradictory data.

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