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Cost effectiveness of golimumab for the treatment of active psoriatic arthritis |
Cummins E, Asseburg C, Prasad M, Buchanan J, Punekar YS |
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Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical assessment on the reliability of the study and the conclusions drawn. CRD summary The study evaluated the cost-effectiveness of golimumab among patients with active psoriatic arthritis in the UK. The authors concluded that once monthly golimumab was a cost-effective treatment for patients with active psoriatic arthritis compared with palliative care plus disease modifying antirheumatic drugs. The quality of the study methodology was good, with both methods and results reported adequately. Given the scope of the study, the authors’ conclusions appear to be appropriate. Type of economic evaluation Study objective The study estimated the cost-effectiveness of golimumab among patients with active psoriatic arthritis in the UK. Interventions The three subcutaneous tumour necrosis factor (TNF)-alpha inhibitor interventions evaluated were golimumab (licensed dose of 50mg once monthly), adalimumab, and etanercept. Each TNF-alpha inhibitor was compared with palliative care plus disease modifying antirheumatic drugs (DMARDs). Location/setting UK/outpatient secondary care. Methods Analytical approach:A previously published decision model was adopted to include golimumab as an additional treatment alternative for active psoriatic arthritis (Cummins, et al. 2011 see Other Publications of Related Interest). The time horizon was 40 years. The authors stated that the UK NHS perspective was adopted. Effectiveness data:The clinical and effectiveness estimates came from clinical trials. Due to the lack of head-to-head efficacy data for the different interventions, evidence synthesis techniques were used to estimate the relative efficacy of the intervention drugs compared with palliative care. The main measures of effectiveness used in the model were psoriatic arthritis response criteria (PsARC) response to treatment, the effect on Health Assessment Questionnaire (HAQ) score, and the effect on Psoriasis Area Severity Index (PASI) score. Monetary benefit and utility valuations:Utility values were obtained by using a published algorithm that converted HAQ and PASI scores into utilities (Rodgers, et al. 2009 see Other Publications of Related Interest). Measure of benefit:The measure of benefit was quality-adjusted life-years (QALYs). Future benefits were discounted using an annual rate of 3.5%. Cost data:The direct costs included drug administration and monitoring, and psoriatic arthritis treatment (including in-patient, outpatient and phototherapy). Drug administration and monitoring costs came from a previously published study (Cummins, et al. 2011). Costs of treating psoriatic arthritis were from a previous study and the expert opinion of 20 dermatologists. All costs were updated to 2009 prices using healthcare inflation indices and were reported in UK £. Future costs were discounted using an annual rate of 3.5%. Analysis of uncertainty:One-way sensitivity analyses were conducted by varying model parameters such as baseline HAQ and PASI scores, time horizon, HAQ rebound, HAQ reduction, withdrawal rates and HAQ progression. An additional probabilistic sensitivity analysis was performed surrounding important variables with 10,000 simulations. Results For palliative care plus DMARDs, the total cost per patient was £62,224 and the average QALYs gained were 5.44 For golimumab, the total cost per patient was £94,151 and the average QALYs gained were 7.34. For adalimumab, the total cost per patient was £86,410 and the average QALYs gained were 6.97. For etanercept, the total cost per patient was £94,578 and the average QALYs gained were 7.69. Costs and benefits were combined using an incremental cost-utility ratio (the additional cost per QALY gained). When compared with palliative care plus DMARDs, the additional cost per QALY gained was £16,811 with golimumab, £15,820 with adalimumab, and £14,402 with etanercept. Results of the probabilistic sensitivity analysis showed that the probability of golimumab being cost-effective was 50% at a willingness to pay per QALY threshold of £20,000 and 89% at a willingness to pay per QALY threshold of £30,000. Authors' conclusions The authors concluded that once monthly golimumab was a cost-effective treatment for patients with active psoriatic arthritis compared with palliative care plus disease modifying antirheumatic drugs. CRD commentary Interventions:The interventions were reported adequately. The interventions appear to have been appropriate comparators and were the usual practice in the authors' setting of the UK NHS. These comparators might be suitable for other settings. Effectiveness/benefits:Clinical and effectiveness estimates came from previously published studies. Most of the effectiveness data were from randomised controlled trials, which should have high validity. Brief details were provided of the indirect evidence synthesis techniques used to determine the relative efficacy of the different interventions. However, the authors did not report how previously published studies were identified and whether a systematic review of the literature was undertaken. As a result, it was not possible to determine if all relevant studies were included in the analysis. QALYs were an appropriate benefit measure, which captured the impact of the interventions on quality of life and survival. The details of the derivation of the utility values were reported. Costs:The perspective adopted was explicitly reported as that of the NHS. For this perspective it would appear that all relevant major costs were included; these appear to have been appropriate for the setting of the UK NHS. The cost sources were adequately reported. The price year, time horizon and discount rate were all reported. Analysis and results:A decision model was used to synthesise the cost and outcome information. Adequate details of the model structure were provided, including a diagram. The results were clearly reported. The impact of uncertainty on the model’s results was adequately tested using one-way and probabilistic sensitivity analyses. The authors acknowledged that a main limitation to their study was certain assumptions on the rebound effect (for patients coming off treatment); these were made as there was only inconclusive evidence of rebound effect in the literature. Concluding remarks:The quality of the study methodology was good, with both methods and results reported adequately. Given the scope of the study, the authors’ conclusions appear to be appropriate. Funding The study was jointly funded in full by Schering-Plough Ltd and Centocor Ortho Biotech Inc.; the writing of the paper was funded in full by Schering-Plough Ltd. At the time of writing, two authors were employees of Schering-Plough Ltd and one author was an employee of Centocor Ortho Biotech Inc. Bibliographic details Cummins E, Asseburg C, Prasad M, Buchanan J, Punekar YS. Cost effectiveness of golimumab for the treatment of active psoriatic arthritis. European Journal of Health Economics 2012; 13(6): 801-809 Other publications of related interest Cummins E, Asseburg C, Punekar YS, Shore E, Morris J, Briggs A, Fenwick E. Cost-effectiveness of infliximab for the treatment of active and progressive arthritis. Value in Health 2011; 14(1): 15-23. Rodgers M, Epstein D, Bojke L, Yang H, Craig D, Fonseca T, Myers L, Bruce I, Chalmers R, Bujkiewicz S, Lai M, Cooper N, Abrams K, Spiegelhalter D, Sutton A, Sculpher M, Woolacott N. Etanercept, infliximab and adalimumab for the treatment of psoriatic arthritis: a systematic review and economic evaluation. Health Technology Assessment 2011; 15(10): 1-329. Indexing Status Subject indexing assigned by NLM MeSH Antibodies, Monoclonal /economics /therapeutic use; Arthritis, Psoriatic /drug therapy; Cost-Benefit Analysis; Female; Great Britain; Humans; Male; Middle Aged; Models, Economic; Quality-Adjusted Life Years; Surveys and Questionnaires; Tumor Necrosis Factor-alpha /economics /therapeutic use AccessionNumber 22013000607 Date bibliographic record published 31/01/2013 Date abstract record published 27/02/2013 |
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