Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-11T05:49:15.671Z Has data issue: false hasContentIssue false
  • English
  • Français

Modeling the cost-effectiveness of treatment of rheumatoid arthritis with rituximab using registry data from Southern Sweden

Published online by Cambridge University Press:  31 March 2009

Peter Lindgren ,
Pierre Geborek  and
Gisela Kobelt
Peter Lindgren
Affiliation:
i3/innovus and Karolinska Institute
Pierre Geborek
Affiliation:
University of Lund and Lund University Hospital
Gisela Kobelt
Affiliation:
European Health Economics
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives: The aim of this study was to estimate the cost-effectiveness of rituximab in patients not responding adequately to the first tumor necrosis factor (TNF) inhibitor using a model constructed to predict resource consumption and health outcomes in a population-based registry of biological treatments in Southern Sweden (SSATG).

Methods: The model was developed as a discrete event simulation model, using SSATG data for the years 1999–2007. The data set included 1,903 patients with complete data on treatments (up to three treatment lines), functional capacity (HAQ), disease activity (DAS28), and utility (EQ-5D). Resource consumption was based on a regular population-based survey of patients in Southern Sweden. Rituximab was incorporated as second line treatment, using effectiveness data for the active group (N = 311) in a clinical trial comparing rituximab to placebo (REFLEX). It is thus compared to the mix of second line biologics used in SSATG. The analysis starts after failure of the first TNF inhibitor. Results are reported as costs (€2008) per quality-adjusted life-year (QALY; both discounted 3 percent), for the societal perspective in Sweden.

Results: Total costs in the rituximab strategy are estimated at €401,100 compared with €403,000 in the TNF-inhibitor arm. Total QALYs are 5.98 and 5.78, respectively. The findings were found to be robust in extensive sensitivity analysis.

Conclusions: In our model, a strategy where rituximab is used as second line treatment after failure of the first TNF inhibitor provides a small saving (essentially due to the lower price of rituximab) and a QALY gain (due to better effect than the mix of second line TNF inhibitors).

Keywords

Cost-effectivenessRheumatoid arthritisSwedenRA registriesRituximab
Type
General Essays
Information
International Journal of Technology Assessment in Health Care , Volume 25 , Issue 2 , April 2009 , pp. 181 - 189
Copyright
Copyright © Cambridge University Press 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1. Askling, J, Fored, CM, Brandt, L et al. , Time-dependent increase in risk of hospitalisation with infection among Swedish RA patients treated with TNF antagonists. Ann Rheum Dis. 2007;66:1339–1344.CrossRefGoogle ScholarPubMed
2. Bansback, N, Ara, R, Karnon, J, Anis, A. Economic evaluations in rheumatoid arthritis: A critical review of measures used to define health States. Pharmacoeconomics. 2008;26:395–408.Google Scholar
3. Brennan, A, Bansback, N, Nixon, R et al. , Modelling the cost effectiveness of TNF-{alpha} antagonists in the management of rheumatoid arthritis: Results from the British Society for Rheumatology Biologics Registry. Rheumatology (Oxford). 2007;46:1345–1354.Google Scholar
4. Cohen, SB, Emery, P, Greenwald, MW et al. , Rituximab for rheumatoid arthritis refractory to anti-tumor necrosis factor therapy: Results of a multicenter, randomized, double-blind, placebo-controlled, phase III trial evaluating primary efficacy and safety at twenty-four weeks. Arthritis Rheum. 2006;54:2793–2806.Google Scholar
5. Dolan, P, Gudex, C, Kind, P, Williams, A. A social tariff for EuroQol: Results from a UK general population survey. York: Centre for Health Economics, University of York; 1995.Google Scholar
6. The Euroqol Group. EuroQol – a new facility for the measurement of health-related quality of life. Health Policy. 1990;16:199–208.Google Scholar
7. Fass Läkemedel i Sverige (Pharmaceutical Lexicon), pp. ISBN 91–85314-71–4. Stockholm: Lakemedelsinformation AB; 2008.Google Scholar
8. Finckh, A, Ciurea, A, Brulhart, L et al. , B cell depletion may be more effective than switching to an alternative anti-tumor necrosis factor agent in rheumatoid arthritis patients with inadequate response to anti-tumor necrosis factor agents. Arthritis Rheum. 2007;56:1417–1423.Google Scholar
9. Gabriel, SE, Crowson, CS, Kremers, HM et al. , Survival in rheumatoid arthritis: A population-based analysis of trends over 40 years. Arthritis Rheum. 2003;48:54–58.CrossRefGoogle ScholarPubMed
10. Geborek, P, Saxne, T. Clinical protocol for monitoring of targeted therapies in rheumatoid arthritis. Rheumatology (Oxford). 2000;39:1159–1161.CrossRefGoogle ScholarPubMed
11. Hjardem, E, Ostergaard, M, Podenphant, J et al. , Do rheumatoid arthritis patients in clinical practice benefit from switching from infliximab to a second tumor necrosis factor alpha inhibitor? Ann Rheum Dis. 2007;66:1184–1189.Google Scholar
12. Jacobsson, L, Lindroth, Y, Marsal, L, Tejler, L. Malmömodellen för privat och offentlig reumatologisk öppenvard. Läkartidningen. 2001;98:4710–4716.Google Scholar
13. Jacobsson, L, Lindroth, Y, Marsal, L et al. , Rheumatoid arthritis: What does it cost and what factors are driving those costs? Results of a survey in a community-derived population in Malmo, Sweden. Scand J Rheumatol. 2007;36:179–183.CrossRefGoogle Scholar
14. Jacobsson, L, Turesson, C, Nilsson, JA et al. , Treatment with TNF blockers and mortality risk in patients with rheumatoid arthritis. Ann Rheum Dis. 2007;66:670–675.Google Scholar
15. Karlsson, JA, Kristensen, LE, Kapetanovic, MC et al. , Treatment response to a second or third TNF-inhibitor in RA: Results from the South Swedish Arthritis Treatment Group Register. Rheumatology (Oxford). 2008;47:507–513.Google Scholar
16. Keystone, E. Switching tumor necrosis factor inhibitors: An opinion. Nat Clin Pract Rheumatol. 2006;2:576–577.CrossRefGoogle ScholarPubMed
17. Kobelt, G. Health economic issues in rheumatoid arthritis. Scand J Rheumatol. 2006;35:415–425.Google Scholar
18. Kobelt, G, Eberhardt, K, Geborek, P. TNF-inhibitors in the treatment of rheumatoid arthritis in clinical practice: Costs and outcomes in a follow-up study of patients with RA treated with etanercept or infliximab in southern Sweden. Ann Rheum Dis. 2004;63:4–10.Google Scholar
19. Kobelt, G, Lindgren, P, Geborek, P. Modelling cost and quality of life of treatment of RA with biological agents in clinical practice. Scand J Rheumatol. in press.Google Scholar
20. Kobelt, G, Lindgren, P, Lindroth, Y, Jacobson, L, Eberhardt, K. Modelling the effect of function and disease activity on costs and quality of life in rheumatoid arthritis. Rheumatology (Oxford). 2005;44:1169–1175.Google Scholar
21. Kobelt, G, Lindgren, P, Singh, A, Klareskog, L. Cost effectiveness of etanercept (Enbrel) in combination with methotrexate in the treatment of active rheumatoid arthritis based on the TEMPO trial. Ann Rheum Dis. 2005;64:1174–1179.CrossRefGoogle ScholarPubMed
22. Kristensen, LE, Kapetanovic, Mc, Gulfe, A et al. , Predictors of response to anti-TNF therapy according to ACR and EULAR criteria in patients with established RA: Results from the South Swedish Arthritis Treatment Group Register. Rheumatology (Oxford). 2008;47:495–499.Google Scholar
23. Scott, D, Pugner, K, Kaarela, K et al. , The links between joint damage and disability in rheumatoid arthritis. Rheumatology. 2000;39:122–132.CrossRefGoogle ScholarPubMed
24. Söderlin, MK, Geborek, P. Changing pattern in the prescription of biological treatment in rheumatoid arthritis. A 7-year follow-up of 1839 patients in southern Sweden. Ann Rheum Dis. 2008; 2008;67:37–42Google Scholar
25. Statistics, Sweden. Statistiska Centralbyran. www.scb.se/plubikat/sm/arbetsmarknad.asp. 2008Google Scholar
26. Turesson, C, O'Fallon, WM, Crowson, CS et al. , Occurrence of extraarticular disease manifestations is associated with excess mortality in a community based cohort of patients with rheumatoid arthritis. J Rheumatol. 2002;29:62–67.Google Scholar
27. Van Vollenhoven, R, Harju, A, Brannemark, S, Klareskog, L. Treatment with infliximab (Remicade) when etanercept (Enbrel) has failed or vice versa: Data from the STURE registry showing that switching tumour necrosis factor alpha blockers can make sense. Ann Rheum Dis. 2003;62:1195–1198.Google Scholar